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DOCTOR  IN  MEDICINE 


AND 


Other   Papers 


ON 


PROFESSIONAL     SUBJECTS. 


BY 


STEPHEN    SMITH. 


NEW  YORK: 

WILLIAM     WOOD     &,     CO. 

27  Geeat  Joneb  SIkeet. 
18  72. 


The  papers  contained  in  this  volume  were 

originally  contributed  to  various  periodicals. 


CONTENTS. 


PAGE. 

I. — Doctor  in  Medicine 1 

II. — Employment  of  Anesthetics  .  6 

III.— Physician  and  Apothecary  ...  13 

IV. — Kecruits  for  the  Profession  .  22 

V. — Suicide  in  the  Tombs 29 

VI. — Nostrum  Advertising 34 

VII. — Past  and  Present 38 

VIII. — Prevention  of  Crime 43 

IX. — Care  of  Infants 49 

X. — Woman  as  Physician 54 

XL — Foreign  Emigration 59 

XII. — What  Shall  we  Read  ? .  64 

XIII. — Duties  of  Coroner 69 

XIV. — The  Sabbath  Question 74 


VI  CONTENTS. 

XV. — The  Illegitimate 81 

XVI. — CONSERVATIVE  SURGERY 87 

XVII. — Public  Benefactors 92 

XVIII. — Preliminary  Education 98 

XIX. — The  Age  of  Uterine  Disease    104 

XX. — Hospital  Construction 109 

XXI. — Our  Status  Abroad 112 

XXII. — Concentrated  Medicines 117 

XXIII. — Mechanical  Surgery 122 

XXIV.— Color  Blindness 126 

XXV. — Literature  in  Medicine 130 

XXVI. — Female  Nurses  in  Hospitals  .  134 

XXVII. — Maternal  Vigilance 140 

XXVIII. — A  Suspense  of  Faith 144 

XXIX. — The  Physician  as  Citizen 149 

XXX. — Medical  Experts 154 

XXXI. — Incurable  Diseases 159 

XXXII. — Mortality  in  Hospitals 164 

XXXIII. — Diseases -of  Conscripts 172 


CONTENTS.  Vll 

XXXIV. — Prescription  Writing 177 

XXXV.— Diseased  Meats 181 

XXXVL— RlOTS  AND  THEIR  PREVENTION .  .    188 

XXXVII. — Education  of  Infants 195 

XXXVIII.— Physicians  in  Old  Age 199 

XXXIX.  —Fee  and  Contract 204 

XL. — Crime  of  Abortion 208 

XLL— Revision  of  Fee-Bills 213 

XLII. — Confidential  Communications  216 
XLIIL— Civil  and  Military  Surgeons  .  221 
XLIV. — New  School  of  Obstetrics  . . .  225 

XLV.— Specialists  in  Medicine 229 

XL VI. — Gratuitous  Services 233 

XL VII. — Alleged  Criminals 238 

XL VIII.— Modern  Military  Science  —  242 
XLIX.— Hospital  Appointments..  „-....  247 

L. — Asylums  for  Inebriates 251 

LI. — Surgeon  and  Patient 256 

LII. — Writer's  Cramp 260 


viii  CONTENTS. 

LIII.^-The  Great  Destroyer 263 

LIV .— Study  of  Medical  Ethics 267 

LV. — The  Grand  Army 270 

LVL— Eesponsibility  of  Physicians  .  277 

LVIL— Medical  Men  vs.  Medical  Men  283 

LYIIL— The  Art  of  Teaching  Medicine  289 


DOCTOR  IN  MEDICINE. 


A  GRAVE  question  must  ere  long  present 
itself  for  the  consideration  of  the  medical 
profession  of  this  country,  on  the  solution  of  which 
will  depend  its  character  at  home  and  its  position 
abroad,  viz.,  By  what  title  shall  a  practitioner  of 
legitimate  medicine  be  recognized  ?  What  shall 
constitute  a  Doctor  in  Medicine?  Hitherto  it 
has  been  deemed  sufficient  that  an  applicant  for 
admission  to  a  regularly  organized  society  should 
present  credentials  showing  him  to  be  a  graduate 
of  a  chartered  medical  college,  or  a  licentiate  of 
a  County  or  State  medical  society.  But  the  ease 
with  which  charters  are  now  obtained  from  State 
Legislatures  for  every  nondescript  association  of 
men,  whether  for  proper  or  improper  purposes, 
has  effectually  broken  down  these  safeguards  to 
respectability,  and  thrown  widely  open  the  field 
of  medicine  to  every  one  who  desires  to  enter  and 
profit  thereby.  With  the  single  and  most  hon- 
orable exception  of  the  State  of  North  Carolina, 
we  are  not  aware  that  any  State  has  laws  protect- 
ing the  domain  of  scientific  medicine  from  the 
intrusion  of  lawless  adventurers.  It  will  ever 
redound  to  the  honor  of  the  old  North  State, 
1 


Z  DOCTOR  IN  MEDICINE. 

that  lier  legislators  have  shown  such  wisdom  and 
intelligence,  in  ordaining  that  no  one  can  assume 
the  office  of  physician  within  her  borders,  who 
has  not  passed  an  examination  before  a  State 
Board  of  Medical  Examiners.  In  our  own  State, 
not  only  is  the  utmost  license  given  to  every  spe- 
cies of  charlatanry,  but  the  chartered  institutions 
of  irregulars  are  placed  on  the  same  level  with 
others,  and  the  one  may,  by  a  civil  process,  even 
be  compelled  to  receive  into  membership  the 
graduates  of  the  other.  The  recent  attempts  to 
establish  a  Homoeopathic  Professorship  in  the 
Michigan  University  and  the  efforts  of  this  class 
of  practitioners  to  obtain  positions  in  hospitals, 
are  indications  of  approaching  evils  that  we 
would  do  well  to  heed,  and,  by  timely  action, 
avert.  Our  attention  has  been  especially  called 
to  this  subject  by  the  recent  application  of  sev- 
eral graduates  of  Homoeopathic  Colleges  in  the 
United  States,  to  the  British  Medical  Council,  to 
be  registered  under  the  clause  admitting  gradu- 
ates of  Foreign  Universities.  The  council  found 
itself  in  a  quandary,  but  finally  referred  the  mat- 
ter to  the  Attorney-General  to  advise  the  Coun- 
cil as  to  its  duties.  It  is  not  difficult  to  predict 
the  result  of  this  inquiry;  the  institutions  re- 
ferred to  will  be  found  legally  authorized  to  con- 
fer the  degree  of  M.  D.,  and  the  applicants  will, 
doubtless,  be  admitted  to  registration.  It  may 
be  a  serious  defect  in  the  Registration  Act,  which 
is  designed  to  distinguish  qualified  from  unquali- 


DOCTOR  IN  MEDICINE.  3 

fied  practitioners,  that  the  Medical  Council  has 
not  power  to  decide  as  to  the  character  as  well  as 
to  the  legal  status  of  the  Foreign  University  from 
which  the  applicant  claims  to  have  graduated. 
But  this  does  not  concern  us  so  much  as  the 
question  which  has,  in  fact,  been  put  to  us  by 
this  action  of  the  Medical  Council,  viz. :  What 
constitutes  a  Doctor  in  Medicine  in  the  United 
States  ?  We  should  answer  truly  if  we  replied  : 
The  assumption  of  the  title  M.  D.  Neither  the 
law  nor  the  publie  require  more,  and  both  unite 
to  protect  the  pretender  in  acting  out  his  as- 
sumed character.  But  to  be  more  exact  in  the 
definition,  we  should  answer  :  Any  institution  or 
society  which  has  the  power  granted  it,  in  its 
charter,  of  conferring  the  degree  of  M.  D.  The 
laws  in  this  country  do  not  differ  in  this  respect, 
we  believe,  from  those  of  other  countries,  except 
in  these  important  particulars :  Charters  are 
granted  by  our  State  Legislatures  to  any  and 
every  body  of  men,  for  any  and  every  conceiva- 
ble purpose,  without  restriction  or  reserve ;  while 
abroad,  great  discretion  is  exercised  both  as  to 
the  object  of  the  corporate  body,  its  necessity, 
and  its  character.  Its  powers  are  carefully  lim- 
ited, and  it  is  jealously  watched  that  it  fulfill  its 
duties.  With  us  the  case  is  widely  different.  At 
nearly  every  session  of  our  State  Legislatures  a 
brood  of  medical  institutions  are  chartered  em- 
bracing every  conceivable  shade  of  quackery,  all 
equally  with  the  schools  of  legitimate  medicine 


4  DOCTOR  IN  MEDICINE. 

entitled  to  confer  the  degree  of  M.  D.  and  to 
represent    themselves    abroad    as   Universities. 
We  shall  leave  the  Medical  Council  to  settle  this 
question  as  they  think  proper  after  hearing  the 
opinion  of  their  legal  adviser.     We  may,  how- 
ever, assure  our  brethren  abroad  that,  in  the 
United  States,  the  title  of  M.  D.,  in  a  legal  sense, 
is  a  misnomer,  and  that  the  term  university  is 
applied  equally  to  our  most  honorable  and  useful 
institutions  of  learning,  and  to  corporations  ut- 
terly unworthy  of  the  association  of  the  term — 
science.    To  the  medical  profession  of  this  coun- 
try we  put  the  question  :  What  is  to  constitute  a 
Doctor  in  Medicine  among  us,  and  by  what  title 
or  insignia  shall  an  American  physician  be  dis- 
tinguished abroad  ?     Had  we  but  one  legislative 
body  before  which  we  could  lay  our  grievances, 
we  might  seek  and  obtain  enactments  defining 
who  are,  and  who  are  not,  qualified  practitioners 
of  medicine.    But  as  we  must  appeal  to  our  State 
Legislatures,  so   fickle  in  their   action,   and  so 
much  under  the  influence  of  the  prejudices  of 
the  moment,  it  is  idle  to  waste  time  in  seeking 
legal  protection.     The  barriers  erected  one  year 
with  labor  and  care,  are  the  next  levelled  by  the 
first  breath  of  opposition.     But  happily  there  is 
a  power  among  us  whose  jurisdiction  extends  to 
the  remotest  limits  of  our  country,  and  whose 
decision  will  be  respected.     That  power  is  the 
American    Medical    Association,    oin*    National 
Medical  Congress.     Standing  as  the  recognized 


DOCTOK  IN  MEDICINE.  ^       5 

representative  body  of  legitimate  medicine  in 
this  country,  high  above  all  law,  and  enforcing 
its  mandates  by  an  inherent  moral  force,  it  can 
legislate  for  its  own  protection,  and  no  evil  in- 
fluence can  reverse  its  measures,  or  thwart  its 
designs.  This  Medical  Congress  has  the  power 
to  determine  what  title  shall  hereafter  designate 
the  practitioner  of  legitimate  medicine,  and  to 
this  body  the  profession  must  make  their  appeal. 
Perhaps  the  simplest  method  of  attaining  the 
desired  end  would  be  by  a  certificate  of  member- 
ship of  this  National  Association  and  an  appro- 
priate title.  We  could  thus  at  once  separate  the 
herd  of  pretenders,  and  give  to  each  person  bear- 
ing such  title  and  certificate,  an  honorable  dis- 
tinction at  home  and  abroad.  But  whatever  plan 
might  be  adopted,  the  necessity  for  action  is  be- 
coming daily  more  and  more  pressing,  and  can 
not  much  longer  be  delayed,  if  we  would  rescue 
the  profession  from  a  position  so  anomalous  that 
the  false  can  not  be  distinguished  from  the  true, 
by  our  foreign  brethren.  And  we  believe  that 
such  distinctive  title  would  tend  powerfully  to 
elevate  the  rank  and  general  character  of  medical 
men  in  this  country,  as  it  would  be  eagerly  sought 
after  by  every  respectable  and  qualified  graduate. 


II. 

EMPLOYMENT  OF  ANESTHETICS. 


THE  discovery  of  anaesthetics  was  universally 
hailed  as  a  great  and  unqualified  blessing  to 
the  victims  of  unavoidable  pain.  The  year  of  the 
announcement  of  the  power  of  ether  to  render  the 
patient  insensible  under  the  hand  of  the  operator, 
was  distinguished  as  the  annus  mirabilis ;  it  be- 
gan a  new  era  in  the  history  of  operative  surgery, 
and  the  older  surgeon,  in  the  language  of  the 
elder  Warren,  "  wished  again  to  go  through  his 
career  under  the  new  auspices."  We  can  well 
imagine  with  what  enthusiasm  he  who  had  been 
accustomed  to  struggle  through  difficult  opera- 
tions on  patients  forcibly  held,  now  pursued  his 
dissections  as  on  the  cadaver,  and  saw  the  pa- 
tient, on  the  completion  of  ^the  operation,  sud- 
denly restored  to  a  full  possession  of  all  his  facul- 
ties, as  if  by  magic.  And  when,  a  year  or  more 
after  these  first  experiments  with  ether,  chloro- 
form was  introduced  to  notice,  so  agreeable  to 
the  senses,  so  prompt  in  its  action,  and  so  harm- 
less in  its  effects,  the  perfection  of  anaesthetic 
agencies  was  thought  to  have  been  attained. 
But  every  good  must  have  its  corresponding  ill. 
It  was  soon  announced  that  a  lady,  sitting  in  a 


EMPLOYMENT  OF  ANAESTHETICS.  7 

dentist's  chair,  had  suddenly  expired  while  inhal- 
ing chloroform  preparatory  to  the  extraction  of  a 
tooth.  A  second,  third,  and  fourth  case  was  re- 
ported, and  always  previously  to  some  trivial 
operation.  The  faith  of  its  friends,  however,  re- 
mained unshaken,  and  these  unfortunate  results 
were  attributed  to  the  attending  circumstances, 
and  not  to  the  anaesthetic.  At  length  fatal  cases 
began  to  occur  occasionally  in  hospitals,  in  the 
presence  of  eminent  physicians  and  surgeons, 
and  in  spite  of  their  previous  precautions,  and 
efforts  to  resuscitate  the  victim.  Finally,  the  fact 
seemed  established  beyond  a  peradventure,  that 
chloroform  is  not  an  innocuous  agent,  even  under 
circumstances  apparently  the  most  favorable  for 
its  administration,  by  the  occurrence  of  a  fatal 
case  (in  a  dentist's  chair,  however),  in  spite  of  the 
persistent  and  well-directed  efforts  of  Professor 
Simpson  hiinself  to  restore  animation.  It  can 
now  no  longer  be  denied  that  anaesthetics  are 
followed  by  unpleasant  and  occasionally  fatal 
effects  in  a  given  number  of  instances.  The 
latest  statistics  that  have  been  published  are  as 
follows  :  Total  fatal  cases  in  Europe,  one  hundred 
and  twenty-five.  When  we  take  into  account  the 
aggregate  of  cases  of  ansesthetization  during  the 
last  sixteen  or  seventeen  years,  of  their  almost 
universal  use  in  hospitals,  and  in  private  practice, 
this  mortality  is  a  percentage  of  the  whole  num- 
ber of  cases  positively  infinitesimal.  It  is  doubt- 
ful if  any  active  remedy  of  the  materia  meclica 


8  EMPLOYMENT  OF  ANESTHETICS. 

can  show  a  better  record.  The  recent  death  by 
chloroform  in  Bellevue  Hospital  has,  we  under- 
stand, raised  the  question  in  the  Medical  Board 
as  to  the  propriety  of  allowing  this  agent  to  be 
longer  employed  for  purposes  of  anaesthesia  in 
that  institution.  Before  this  question  can  be 
properly  decided,  the  comparative  merits  of  ether 
and  chloroform  must  be  considered,  for  anaesthet- 
ics in  some  form  are  now  indispensable  to  the 
practice  of  operative  surgery  and  midwifery,  and 
can  never  be  discarded,  even  though  the  mor- 
tality from  their  use  were  tenfold  its  present  per- 
centage. And  before  chloroform  is  stricken  from 
the  list,  it  were  well  to  inquire  as  to  the  real 
sources  of  danger  for  its  use,  for  if  it  is  demon- 
strated that  under  certain  circumstances  it  is  as 
safe  as  any  anaesthetic,  every  surgeon  will,  under 
such  circumstances,  prefer  chloroform.  The  com- 
parative merits  of  ether  and  chloroform,  as  an  aes- 
thetics, it  is  not  easy  to  decide.  The  statistics 
which  we  have  given  above  show,  that  of  the  one 
hundred  and  twenty-five  fatal  cases  from  anaes- 
thetics in  Europe,  twenty-five  occurred  during 
the  inhalation  of  ether,  and  one  hundred  of  chlo- 
roform, giving  a  mortality  from  the  latter  equal 
to  four-fifths  of  all  the  cases.  Although  chloro- 
form would  seem  by  this  exhibit  to  be  the  more 
fatal  anaesthetic,  yet  a  moment's  reflection  will 
convince  any  one  that  it  may  not  even  approxi- 
mate  the  truth,  for  we  have  no  knowledge  of  the 
percentage  of  deaths  to  the  number  of  cases  of 


EMPLOYMENT  OF  ANESTHETICS.  ^      9 

administration  of  either  agent.  It  might,  and 
probably  would  appear,  could  we  sift  this  subject 
thoroughly,  that  chloroform  had  been  given  four 
times  as  often  as  ether  during  that  period.  We 
may,  however,  arrive  at  a  very  satisfactory  con- 
clusion as  to  the  safety  of  chloroform,  by  taking 
the  gross  number  of  cases  of  its  administration 
in  certain  well-authenticated  instances,  and  not- 
ing the  results.  For  example,  it  was  given  twen- 
ty-five thousand  times  by  the  French,  in  the  Cri- 
mean war,  without  a  single  fatal  issue.  It  is 
freely  used  in  midwifery  by  many  eminent  Eng- 
lish and  American  obstetricians,  and,  we  believe, 
no  fatal  case  has  yet  been  reported  hi  this  depart- 
ment of  practice.  Professor  Simpson  is  stated  to 
have  used  from  five  to  seven  gallons  annually  for 
some  thirteen  years,  without  an  unfavorable  re- 
sult. The  real  sources  of  danger  in  the  em- 
ployment of  chloroform  have  not  been  sufficiently 
studied.  Authors  mention  :  1st,  A  full  stomach  ; 
for  vomiting  being  a  common  symptom  in  chloro- 
form inhalation,  the  patient  is  liable  to  be  suffo- 
cated. 2d,  Affections  of  the  nervous  system,  as 
delirium  tremens,  epilepsy,  hysteria,  etc.  3d,  Af- 
fections of  the  vascular  system,  as  fatty  degen- 
eration of  the  heart,  atheromatous  deposits,  etc., 
etc.  We  do  not  propose  to  discuss  these  alleged 
contra-indications  to  the  use  of  chloroform,  as  it 
is  by  no  means  as  yet  established  how  far  these 
conditions  are  to  be  regarded  as  complicating  its 
effects.  We  believe,  however,  that  it  was  main- 
1* 


10  EMPLOYMENT  OF  ANESTHETICS. 

tainecl  by  the  late  Dr.  Snow,  whose  opinion  on  all 
subjects  relating  to  chloroform  is  entitled  to  our 
confidence,  that  even  when  lesions  of  the  nervous 
and  vascular  system  do  exist,  chloroform  properly 
administered,  is  far  less  dangerous  than  an  op- 
eration without  an  anaesthetic.  From  some  re- 
cent investigations  as  to  the  nature  of  death  from 
chloroform,  the  following  interesting  facts  appear : 
1st,  That  the  great  majority  of  deaths  (two-thirds) 
occur  in  slight  operations,  and  those  performed 
on  sphincters,  in  tenotomy,  strabismus,  tooth- 
drawing,  etc.,  etc.,  but  few  during  the  larger 
operations,  as  amputations,  resections,  ovarioto- 
my, etc.  2d,  In  the  majority  of  fatal  cases  by  chlo- 
roform, death  occurred  before  the  operation, — 
during  the  first  stage  of  inhalation — the  stage  of 
excitement.  3d,  That  the  deaths  that  have  occur- 
red after  the  operation,  and  were  attributable  to 
the  anaesthetic,  have  generally  been  when  ether 
was  slowly  administered,  or  ether  and  chloroform, 
but  not  pure  chloroform.  Without  dwelling  on 
these  subjects,  which  are  all  of  the  deepest  inter- 
est to  those  who  are  discussiug  the  question  of 
the  relative  or  actual  merits  of  the  different  anaes- 
thetics, we  shall  allude  to  what  we  consider,  if 
not  the  real,  certainly  a  great  source  of  danger  in 
the  use  of  anaesthetics  in  general,  and  chloro- 
form in  particular,  in  our  hospitals.  We  refer  to 
the  gross  and  culpable  carelessness  of  their  ad- 
ministration. Rarely  is  the  patient  carefully  ex- 
amined by  a  competent  person  to  determine  if 


EMPLOYMENT  OF  ANESTHETICS.  11 

there  be  any  contra-indication  to  the  use  of  an- 
aesthetics— a  point  that  should  never  be  neglect- 
ed. The  delicate  and  most  responsible  task  of 
administering  the  agent  is  usually  committed  to 
a  junior  physician,  who  has  no  knowledge  what- 
ever of  the  nature  of  his  duties ;  he  knows  noth- 
ing of  the  different  stages  through  which  the  pa- 
tient is  to  pass,  or  of  the  value  of  the  symptoms 
which  appear  during  the  administration ;  his  in- 
haler is  a  towel  well  saturated,  and  directions 
often  are  to  apply  it  directly  to  the  face.  The 
stage  of  profound  coma  having  been  reached,  the 
operator  seizes  the  scalpel,  and  all  eyes  are  di- 
rected to  its  movements  ;  the  innocent  junior,  all 
absorbed  in  the  operation,  forgets  his  duty,  un- 
consciously drops  the  towel  upon  the  patient's 
face,  and  occasionally  adds  the  weight  of  his 
body,  to  its  suffocating  effect,  as  he  leans  for- 
ward in  the  anxious  pursuit  of  knowledge.  At 
length  a  moan,  or  the  collapse  of  the  jetting 
arteries,  or  the  suggestion  of  a  bystander  more 
interested  in  the  sufferer  than  the  operator,  re- 
calls attention  to  the  condition  of  the  patient. 
Naturally  enough  he  has  ceased  to  breathe ;  the 
operation  is  suspended;  the  messenger  is  dis- 
patched for  brandy  ;  and  in  the  mean  time  arti- 
ficial respiration  by  the  most  improved  method 
is  attempted  by  every  available  means.  Fortu- 
nately the  patient  is  generally  resuscitated,  at 
least  sufficiently  to  have  the  operation  completed, 
and  be  taken  to  the  ward.     We  do  not  here  give 


12  EMPLOYMENT  OF  ANAESTHETICS. 

an  overdrawn  picture,  for  such  scenes  if  haply 
not  more  unpleasant,  may  be  witnessed  in  our 
hospitals  almost  weekly.  The  reform  should 
commence  with  the  mode  of  administration  of 
these  agents.  A  physician  of  known  ability 
should  be  selected  to  administer  the  anesthetic  ; 
we  say  physician,  because  he  will  not  become  so 
much  interested  in  the  operation  as  to  forget  his 
duties.  In  large  hospitals  where  operations  are 
frequent,  it  would  be  an  act  of  prudence  to  ap- 
point a  competent  physician  for  this  special 
duty.  To  his  care  should  be  committed,  so  far 
as  practicable,  every  patient  who  is  about  to  sub- 
mit to  an  operation.  This  is  but  that  precaution 
which  every  surgeon  exercises  in  private  practice, 
and  hence  the  few  cases  of  deaths  from  anaesthet- 
ics which  occur  outside  of  our  hospitals.  If  this 
degree  of  care  is  exercised  in  our  hospitals  and 
still  fatal  consequences  follow  the  use  of  ether  or 
chloroform,  or  both,  the  question  may  well  be 
raised  as  to  the  propriety  of  rejecting  the  more 
dangerous. 


III. 

PHYSICIAN  AND  APOTHECAKY. 


rinHE  memory  of  many  now  living  can  recall 
the  time  when  the  physician  was  his  own 
apothecary,  his  person  all  redolent  of  the  com- 
posite aroma  exhaling  from  the  health-giving 
preparations  which  distended  his  ample  port- 
manteau, and  the  daily  entry  in  his  ledger  gave 
as  prominent  a  place  to  pill  and  potion  as  to  pro- 
fessional advice.  In  the  good  old  times  when 
cinchona  bark,  in  spoonful  doses,  was  the  stand- 
ard febrifuge,  and  calomel  and  jalap  the  officinal 
stimulant  of  torpid  livers  and  sluggish  bowels, 
the  first  lessons  of  the  youthful  candidate  for 
Esculapian  honors  were  in  the  use  of  the  mor- 
tar and  pestle,  and  much  of  his  subsequent 
tuition  consisted  in  acquiring  the  art  of  expertly 
moulding  the  pill  at  his  fingers'  ends.  There 
was  then  little  need  of  laws  against  the  importa- 
tion of  impure  drugs,  for  the  physician  selected 
each  individual  article,  as  he  selected  his  lancet, 
according  to  its  potency.  There  was  then  no 
more  doubtful  interpretation  of  the  action  of  the 
pill  than  the  lancet ;  if  the  latter  refused  to  cut, 
the  fault  was  charged  to  the  temper  of  the  steel, 
and  not  to  a  change  in  the  type  of  the  disease, 


14  PHYSICIAN  AND  APOTHECARY. 

or  a  constitutional  peculiarity  of  the  patient ; 
and  so  of  the  pill,  if  it  did  not  produce  its  de- 
sired effect,  it  was  esteemed  inert,  and  cast  aside 
as  refuse.  Purity  in  the  drug  market  was  then  a 
necessity,  for  the  purchaser  applied  it  directly  to 
its  proper  service,  and  personally  tested  its 
efficacy,  equally  as  does  the  husbandman  the 
quality  of  the  seed  which  his  own  hand  casts 
into  the  soil  carefully  prepared  for  it.  But 
among  the  many  divisions  of  labor  which  the 
progress  of  civilization  induces,  is  that  of  phy- 
sician and  apothecary,  in  dispensing  remedies  to 
the  sick.  The  increase  of  our  cities,  especially 
in  wealth  and  in  the  refinements  of  a  higher 
social  state,  has  called  into  existence  a  class  of 
shop-keepers  who  have  monopolized  the  business 
of  compounding  and  dispensing  medicines.  It 
will  at  once  occur  to  every  reflecting  reader,  that 
this  division  of  labor  is  of  great  importance,  not 
only  to  the  progress  of  pharmacy,  but  equally  to 
that  of  practical  medicine.  While  these  two  de- 
partments remain  united  in  a  single  profession, 
little  improvement  can  be  expected  in  either. 
The  former  will  almost  universally  be  regarded 
as  wholly  subordinate  to  the  latter,  and  receive 
no  other  attention  than  is  deemed  necessary  to 
success  in  the  general  practice  of  medicine. 
And  yet  that  attention  which  the  practitioner  is 
required  to  give  to  the  selection  and  preparation 
of  drugs,  withdraws  him  from  the  close  and  ac- 
curate study  of  those  more  recondite  subjects  on 


PHYSICIAN  AND  APOTHECARY.  _s    15 

which  the  progress  of  medicine  depends.  If  we 
contrast  the  progress  and  present  position  of 
these  departments  in  countries  where  they  have 
been  separated,  with  others  where  they  are  still 
more  or  less  united,  these  statements  are  readily 
proved.  In  France  and  Germany  the  pharma- 
ciens,  or  dispensing  chemists,  have  long  been  a 
distinct  class ;  they  are  compelled  to  qualify 
themselves  by  a  thorough  academic  and  pharma- 
ceutical education,  and  then  follow  their  chosen 
business  exclusively.  The  result  is  seen  in  the 
elevation  of  this  class  as  a  scientific  body,  for  as 
its  representatives  we  may  mention  the  names  of 
Liebig,  Robiquet,  Pelletier,  Persoz,  Dumas, 
Trommsdorf,  Yarentrapp,  Fresenius,  etc.  Their 
innumerable  and  invaluable  contributions,  not 
only  to  pharmacy  but  to  all  departments  of 
chemical  science,  will  occur  to  every  reader. 
The  part  which  these  eminent  pharmaciens  take 
in  the  routine  of  the  druggists'  business,  and  the 
social  and  political  rank  to  which  they  have 
attained,  are  well  given  in  the  following  anecdote 
by  Mr.  Mackay,  of  Edinburgh  : 

"  Professor  Christison  repaired  to  Paris  about  tbirty-four 
years  ago,  to  study  practically  the  higher  branches  of  chem- 
istry. His  adviser  there,  the  late  eminent  physiologist,  Dr. 
Edwards,  recommended,  to  his  surprise  and  amazement, 
that  he  should  place  himself  under  the  tuition  of  a  Chemist 
and  Druggist.  The  Professor's  surprise,  however,  ceased, 
when  he  found  he  was  to  have  for  his  teacher,  under  the 
designation  above  given,  the  late  amiable,  inventive,  scien- 
tific Robiquet.     M.  R.'s  dwelling  communicated  with  his 


16  PHYSICIAN  AND  APOTHECARY. 

boutique  or  shop,  where  lie  superintended  an  extensive  dis- 
pensing establishment,  and  with  his  laboratoire,  or  Chem- 
ist's laboratory,  he,  in  immediate  contact  with  the  ordinary 
routine  of  trade,  carried  on  with  unwearied  enthusiasm 
those  scientific  researches  by  which  the  name  of  Robiquet 
will  ever  be  distinguished  among  the  most  successful 
cultivators  of  chemical  science.  As  if  to  make  the  noth- 
ingness of  Pharmaceutists  in  this  country  at  that  time 
complete,  the  Professor  further  states  it  required  little  ac- 
quaintance with  French  chemistry  to  perceive  that  this 
distinguished  Chemist  was  the  type  of  a  class  in  France 
numerously  rep  resenting  the  higher  walks  of  the  profession 
of  Pharmacy,  men  to  whom  the  world  has  since  assigned 
the  most  elevated  rank  as  chemical  discoverers  in  a  field 
equally  rich  in  scientific  and  practical  results.  Some  of 
these  Pharmaciens  or  dispensing  Chemists  of  Paris  at- 
tained to  the  rank  of  Members  of  the  French  Institute,  the 
rarest  and  highest  of  all  purely  scientific  honors  in  Europe." 

The  reciprocal  advantages  which  practical 
medicine  derives  from  this  entire  monopoly  of 
the  Pharmaceutical  art  by  a  distinct  class  of  emi- 
nently scientific  men,  may  be  seen  in  the  ac- 
tivity of  the  investigations  in  every  branch  of 
medicine  in  these  countries.  In  Great  Britain, 
the  apothecary  is  still  the  medical  practitioner 
to  the  masses,  and  as  a  consequence  the  status 
of  pharmacy  is  very  low,  and  affords  the  most 
striking  contrast  to  that  of  the  continent.  The 
position  and  character  of  the  pharmaceutists  of 
our  own  country  are  in  a  transition  state.  Such 
is  the  state  of  the  medical  profession,  so  low  the 
standard  of  education  required  of  practitioners, 
and  so  large  the  number  who  annually  enter  its 


PHYSICIAN  AND  APOTHECARY.  _y  17 

ranks,  that  the  general  practice  of  our  large 
towns  is  entirely  monopolized  by  regularly 
graduated  physicians,  and  the  apothecary  is 
necessarily  almost  entirely  excluded  from  the 
practice  of  medicine,  and  compelled  to  confine 
himself  to  the  business  of  his  shop.  But  a  new 
evil  springs  from  the  limitation  of  his  occupa- 
tion ;  finding,  in  the  immense  competition  to 
which  an  unrestricted  license  to  practice  as  an 
apothecary  gives  rise,  that  the  dispensing  of  medi- 
cines on  prescriptions  pays  but  poorly,  he  be- 
comes the  retailer  of  nostrums,  and  at  length 
extends  his  business  to  the  sale  of  any  article 
which  the  public  taste  may  require.  Accord- 
ingly, he  converts  his  store  into  a  dazzling 
bazaar,  whose  gaily  decked  windows  excel,  by 
day,  in  variety  and  novelty  of  article,  those  of  the 
neighboring  toy- shops,  and  whose  brilliant  and 
variegated  lights  vie,  at  night,  with  those  of  the 
oyster  saloons.  Here  everything  of  a  fancy 
nature  finds  a  place.  In  no  establishment,  save 
a  pawnbroker's  shop,  can  be  found  such  a  collec- 
tion of  heterogeneous  articles  as  in  one  of  our 
attractive  retail  drug-stores.  But  the  American 
Apothecary,  intent  upon  gratifying  every  taste  of 
his  customers,  does  not  always  stop  with  the 
fancy  trade,  but  extends  his  business  to  the 
gratification  of  the  pleasures  of  the  palate,  and 
over  his  counter  retails  liquors  of  the  same  im- 
pure quality  as  his  drugs.  In  this  connection 
we  can  not  forbear  quoting  the  description  of  a 


18  PHYSICIAN  AND  APOTHECARY. 

prominent  house  in  Boston,  a  "  Gem  of  a  Drug 
Store,"  as  it  is  entitled  by  a  correspondent  of 
th3  London  Chemist  and  Druggist,  but  which  is 
a  fair  description  of  such  stores  generally,  so  far 
as  the  proprietors  are  able  to  furnish  them. 

"  This  shop,  which  has  been  recently  opened,  is  located 
on  the  spot  dear  to  all  doctors,  druggists,  and  tavern  keep- 
ers— the  corner  lot ;  and  its  beautifully  variegated  marble- 
paved  entrance  can  not  fail  to  strike  the  most  unobservant. 
On  entering  you  find  the  same  paving  continued  right 
through  ;  counters  also  of  marble,  handsomely  carved  and 
panelled  with  mirrors,  and  interspersed  at  top  with  deep 
show-cases  with  silvered  mountings.  The  counter  scales 
are  also  sunk  in  the  marble,  the  only  portions  visible  being 
the  pans  and  parts  of  the  arms  ;  the  weights  fit  into  vul- 
canite cups  sunk  in  the  counter,  and,  like  the  entire  metal 
work,  are  electroplated.  Of  course  the  never-failing  soda 
fountain  appears ;  it  is  made  of  cased  ruby  glass,  hand- 
somely cut,  and  electroplated  inside.  The  shelves  are 
fitted  at  back  with  mirrors,  and  supported  by  Scagliola 
columns ;  the  bottles  are  of  varied  colors,  and  labelled  in 
gold  in  a  very  elegant  style.  Pots  are  supplanted  by 
shouldered  glass  jars  labelled  to  match  the  bottles, 
grooved  in  the  lids,  and  lined  with  India-rubber;  the  jars 
are  rendered  perfectly  air-tight  by  having  their  necks 
fitted  into  the  grooves.  I  was  shown  some  glass  show-jars 
about  twelve  inches  high,  the  cutting  of  each  of  which 
took  about  seven  days.  The  stock  being  quite  fresh  and 
tastefully  arranged,  produced,  in  conjunction  with  the 
fittings  which  I  have  attempted  to  describe,  a  beautiful 
appearance.  Lubin's  Extract,  Child's  Hair  Brushes, 
Prout's  Tooth  Brushes,  Ede's  Crimson  Ink  and  Diamond 
Cement,  and  the  various  novel  niceties  of  Morgan  Brothers 
(all  of  which  seem  to  have  obtained  a  great  reputation  out 
here)  caught  my  eye.     The   shop,  though  by  no  means 


PHYSICIAN  AND  APOTHECAEY.  ^  19 

large,  occupied  the  proprietors  nine  months  in  preparing, 
and  cost  them  over  £3,000  ;  and  they  now  have  the  satis- 
faction of  transacting  a  thriving  business  in  the  most 
original  and  handsome  store  in  America." 

The  above  sketch  affords  a  melancholy  proof 
of  the  low  state  of  pharmacy  in  this  country. 
Such  a  display  is  surely  not  intended  to  facilitate 
the  dispensing  of  medicines,  but  is  simply  and 
solely  designed  to  attract  customers  to  the  pur- 
chase of  fancy  articles.  It  may  be  inferred  that 
an  American  apothecary  is  not  a  very  brilliant 
ornament  of  the  profession  represented  by  a  Lie- 
big  and  a  Eobiquet.  He  is  in  fact  but  an  ordi- 
nary shopkeeper,  retailing  drugs  in  addition  to 
the  other  and  more  extensive  branches  of  his 
business.  Too  often  he  has  neither  an  academic 
nor  pharmaceutical  education,  but  enters  upon 
his  business,  after  an  apprenticeship  more  brief 
and  less  thorough  than  that  of  the  ordinary  mer- 
chant's clerk.  It  is  not  surprising  that,  with 
such  a  class  of  apothecaries,  adulteration  of 
drugs,  by  every  possible  means,  is  as  much  a 
matter  of  business  as  the  watering  of  milk  by  the 
dairymen.  Nor  need  we  anticipate  any  diminu- 
tion of  the  homicides  and  suicides  by  poisons, 
whatever  may  be  our  laws,  while  our  druggists, 
as  desititute  of  moral  and  professional  obliga- 
tions as  the  common  shopkeeper,  regard  strych- 
nine as  vendible  an  article  as  a  tooth-pick.  But 
the  druggist  is  not  alone  in  this  abuse  of  his  pro- 
fession.    Too  often  the  physician,  also,  is  a  party 


20  PHYSICIAN  AND  APOTHECARY. 

to  the  "  tricks  of  trade,"  and  prostitutes  his  own 
high  calling  to  the  low  arts  of  gain,  by  conniving 
with  the  apothecary.  It  is  not  altogether  a 
novel  occurrence  for  physicians,  of  self-consti- 
tuted respectability,  regularly  to  emerge  from  an 
inferior  drug-store  in  the  vicinity  of  their  resi- 
dences and  commence  their  daily  round  of  visits 
from  this  low  stand-point.  It  very  frequently 
happens  that  patients  are  sent  long  distances  to 
my  druggist  under  the  foolish  pretence  of  the 
cheapness  and  purity  of  his  articles,  when,  in 
truth,  the  physician  and  druggist  have  laid  their 
heads  together  to  cheat  the  patient,  and  share  the 
proceeds  of  their  crime.  Indeed,  the  utterly  dis- 
reputable and  knavish  practice  of  having  a  profit 
or  percentage  on  their  prescriptions,  is  still  fol- 
lowed by  physicians  who  would  fly  into  a  passion 
on  being  accused  of  stealing — a  crime  not  more 
revolting  to  a  truly  conscientious  mind.  But  low 
as  is  the  grade  of  pharmacy  with  us,  we  have  the 
most  cheering  evidences  of  reform.  There  is  a 
band  of  earnest,  enlightened  men  in  that  profes- 
sion, who,  scorning  the  low  mediocrity  toward 
which  the  mass  gravitate,  are  nobly  striving  to 
elevate  the  standard  of  pharmaceutical  education. 
In  our  larger  towns,  as  Boston,  New  York,  Phila- 
delphia, Baltimore,  St.  Louis,  Cincinnati,  and 
Chicago,  schools  of  pharmacy  have  been  estab- 
lished, and  regular  courses  of  instruction  are 
given  by  competent  teachers.  In  addition  to 
these  schools,  the  basis  of  true  reform,  they  have 


PHYSICIAN  AND  APOTHECARY.  J21 

established  a  national  Pharmaceutical  Associa- 
tion, which  comprises  upward  of  three  hundred 
members,  who  are  animated  with  that  spirit  of 
progress  in  the  science  and  art  of  pharmacy, 
which  must  result  in  its  renovation.  Their  an- 
nual gatherings  are  well  attended,  and  the  pub- 
lished proceedings  of  their  meetings  make  a 
volume  respectable  in  size,  and  replete  with 
scientific  information.  We  hail  these  cheering 
tokens  of  a  better  time  coming  for  the  profession 
of  pharmacy.  But  medical  practitioners  are 
deeply  interested  in  the  educational  qualifications 
of  apothecaries,  and  can  not  remain  idle  spec- 
tators of  the  efforts  of  those  who  are  struggling 
to  elevate  the  character  of  their  profession,  and 
purify  it  from  the  gross  abuses  to  which  it  is  sub- 
jected by  unworthy  members.  No  respectable 
physician  will  withhold  his  assent  to  the  follow- 
ing proposition  :  It  is  necessary  to  the  successful 
practice  of  medicine  to  have  educated  and  scien- 
tific apothecaries  to  prepare  and  dispense  medi- 
cines. It  follows  then  that  physicians  should 
patronize  only  that  class  of  druggists  who  are 
educated.  They  should  shun  the  herd  of  so-called 
apothecaries,  whose  brilliant  show- shops  adorn 
nearly  every  corner  of  our  thoroughfares,  and 
direct  their  patients  exclusively  to  regularly  edu- 
cated or  properly  qualified  pharmaceutists — in  a 
word,  to  graduates  of  the  colleges  of  pharmacy. 


IV. 
RECRUITS  FOE  THE  PROFESSION. 


THE  opening  of  the  schools  inaugurates  the 
medical  session  of  the  year.  No  annual  event, 
properly  considered,  is  of  equal  importance  in  the 
republic  of  medicine.  Yet  we  fear  that  it  too  often 
passes  unheeded  by  our  profession,  simply  be- 
cause its  significance  is  not  appreciated.  Let  us 
consider  its  bearing  upon  .the  future  of  American 
medicine.  The  four  or  five  thousands  of  students 
who  are  now  gathering  in  the  schools  throughout 
the  country,  are  the  recruits  who  are  to  replenish 
and  swell  the  ranks  of  that  army  of  practitioners 
which  now  numbers  in  this  country  not  far  from 
forty  thousand.  Is  it  of  little  consequence  that 
these  recruits  are  qualified  by  education,  habits, 
and  moral  training  for  the  peculiar  service  of  the 
physician?  They  are  to  be  our  brethren,  our 
equals,  and  in  the  progress  of  events  they  are  to 
be  the  exponents  of  the  character  of  our  profes- 
sion, and  give  it  rank  in  the  popular  regard.  If 
they  are  thoroughly  qualified  by  previous  educa- 
tion, and  bring  to  the  investigation  of  the  abstruse 
science  of  medicine,  minds  well  disciplined  to  pa- 
tient study  and  accurate  research,  then  will  they 
become  masters  in  its  various  departments,  and 


KECEUITS  FOK  THE  PROFESSION.  _>23 

in  subsequent  life  will  sustain  its  reputation  as  a 
learned  profession.  If  in  addition  to  educational 
qualifications,  they  have  correct  morals,  and  sen- 
sibilities keenly  alive  to  the  sufferings  of  their 
fellows,  then  -will  they  confirm  its  reputation  as 
the  most  humane  profession.  But  if  the  majority 
of  those  who  are  now  abont  to  enter  our  ranks 
have  but  a  limited  education,  dissolute  and  profli- 
gate habits,  and  are  seeking  personal  aggrandize- 
ment as  the  end  and  aim  of  life,  then  they  will 
degrade  the  profession  to  which  they  belong  in 
the  estimation  of  all  whose  opinion  is  entitled  to 
respect  and  consideration.  Could  we  determine 
the  character  of  the  recruits  that  are  to-day  ad- 
mitted to  the  ranks  of  the  army,  we  could  with 
certainty  foretell  the  value  of  that  army,  when 
the  struggle  of  the  conflict  comes.  We  need 
scarcely  add  that  if  we  judge  from  the  past,  many 
who  now  enter  upon  their  medical  studies  have  no 
proper  qualifications.  We  could  wish  that  it 
were  not  so  ;  that  those  who  stand  at  the  thresh- 
old of  the  temple  as  its  guardians,  would  care- 
fully scan  the  applicants  for  admission,  and  turn 
away  to  more  congenial  pursuits  the  ignorant, 
the  immoral,  the  unworthy.  Every  association  of 
men,  for  whatever  purpose,  guards  vigilantly  the 
door  through  which  accession  is  gained  to  its 
ranks.  The  wisest  and  most  trustworthy  are 
stationed  at  the  portals  to  examine  each  candi- 
date that  no  improper  person  may  become  a  mem- 
ber of  its  select  body,  and  change  the  peculiarity 


24  RECRUITS  FOR  THE  PROFESSION. 

of  its  original  organization.  But  the  ancient  and 
honorable  profession  of  medicine  gives  little  heed, 
in  this  country  at  least,  to  the  character  and 
trustworthiness  of  those  who  guard  the  portals  of 
its  temples.  Unconcerned  it  witnesses  the  an- 
nual influx  of  members,  and  sees  the  most  un- 
worthy too  often  elevated  to  the  privileges  and 
honors  of  its  order  without  a  remonstrance.  It 
is  true  that  hitherto  the  profession,  as  a  body, 
has  lacked  the  organization,  and  consequently 
the  power,  to  protect  itself  from  these  degrading 
associations.  The  field  of  legitimate  medicine, 
like  a  wide  domain  imperfectly  hedged,  is  guarded 
by  mercenary  sentinels,  and  thousands,  unquali- 
fied, annually  purchase  admission,  and  with  the 
most  meritorious  garner  its  rich  fruits.  But  a 
better  day  is  dawning  upon  American  medicine, 
and  a  brighter  era  will  ere  long  occur  in  its  his- 
tory. The  profession  at  large  has  an  organization 
which  is  already  sufficiently  powerful,  were  its 
forces  but  properly  directed,  to  protect  its  own 
domain  from  further  incursions.  Through  the 
medium  of  the  American  Medical  Association,  it 
can  erect  such  defences  as  it  chooses,  and  dictate, 
authoritatively,  who  may,  and  who  shall  not,  be 
admitted  to  its  highest  privileges.  That  it  can 
not  compel  the  educating  bodies,  as  by  legal 
force,  to  scan  more  closely  the  preliminary  quali- 
fications of  students,  and  indicate  the  standard  of 
educational  qualifications  of  graduates,  is  very 
true  ;  but  it  can  by  suitable  organization  establish 


RECRUITS  FOR  THE  PROFESSION.  ^25 

its  own  standard  of  education,  have  its  own  ex- 
amining body,  and  confer  its  own  degrees.  The 
exigencies  of  our  times  demand  this  of  the  Ameri- 
can Medical  Association ;  the  honor,  dignity,  and 
character  of  American  medicine  are  approaching 
a  crisis  which  this  body  can  avert.  We  may  not 
now  indicate  the  precise  steps  by  which  this  great 
reform  is  to  be  accomplished,  but  that  the  in- 
itiatory step  must  soon  be  taken,  and  the  work 
resolutely  prosecuted  to  its  consummation,  no 
one  who  has  at  heart  the  honor  'of  our  profession 
can  for  a  moment  doubt.  In  the  collection  of 
medical  schools  which  it  was  our  privilege  to  pre- 
sent in  the  students'  number,  we  have  laid  a  foun- 
dation for  rational  speculation  in  regard  to 
medical  education  in  the  United  States.  It  not 
only  affords  the  opportunity,  much  needed,  of 
learning  the  advantages  which  the  schools  in  dif- 
ferent sections  of  the  country  offer  to  students, 
but  what  is  of  more  consequence,  we  there  learn 
the  value  which  each  school  attaches  to  its  diplo- 
ma. This  valuation  indicates  then*  standard  of 
medical  education.  It  is  not  our  intention  at  this 
time  to  enter  upon  that  critical  examination  of 
the  subject  of  medical  education,  to  which  this 
collection  invites  us,  but  simply  to  offer  some  gen- 
eral conclusions  which  are  apparent  on  a  super- 
ficial examination.  What  will,  perhaps,  prove  to 
the  mass  of  readers  the  most  marked  difference  in 
our  medical  schools,  has  a  sectional  bearing,  viz. 
between  the  Northern  and  Southern  schools.  It 
2 


26       RECRUITS  FOR  THE  PROFESSION. 

will  be  noticed  that  the  fees  in  the  Southern 
schools  are  uniformly  high,  those  most  recently 
established  having  a  scale  as  high  as  the  largest 
and  most  favored  schools  of  the  North.  Among 
the  Northern  schools,  the  scale  of  fees  varies  from 
the  lowest  of  the  Southern  schools  to  the  price  of 
the  parchment  for  a  diploma.  If  the  scale  of  fees 
indicates  anything  as  regards  the  estimate  of  the 
school  of  its  educational  advantages,  and  the 
value  of  a  thorough  medical  education,  this  ex- 
hibition of  figures  shows  a  vastly  higher  appreci- 
ation of  a  medical  education  at  the  South  than  at 
the  North.  The  next  most  striking  feature  in  the 
schools  is  the  almost  universal  interest  now  mani- 
fested in  clinical  instruction.  This  is  indeed  the 
most  hopeful  sign  of  the  times.  Heretofore  the 
importance  which  the  schools  attached  to  clinical 
advantages  depended  entirely  upon  the  facilities 
which  their  particular  location  happened  to  afford. 
The  school  so  unfortunate  as  to  have  a  situation 
distant  from  any  hospital  or  infirmary,  loudly  de- 
cried clinical  instruction,  and  many  will  remember 
that  a  venerable  professor  went  so  far  a  few  years 
ago  as  to  regard  it  as  absolutely  injurious  to  the 
student.  Schools  situated  in  our  lake  and  sea- 
port towns  saw  their  advantage,  and  vaunted 
their  facilities  for  clinical  instruction,  and,  not 
unfrequently,  published  in  their  annual  circulars 
a  list  of  all  the  medical  institutions  of  the  town, 
many  of  which  were  not  even  open  to  a  transient 
visitor.     Although  clinical  instruction,  as  given  in 


EECItUITS  FOR  THE  PROFESSION.  Jll 

our  colleges  and  hospitals,  lacks  system,  and  is  as 
inefficient  as  it  well  can  be,  still  we  attach  to  it  so 
much  inrportance,  that  we  regard  this  evident  de- 
sire on  the  part  of  the  schools  to  afford  such  ad- 
vantages to  their  pupils  as  in  the  highest  degree 
encouraging.  Again,  it  will  be  noticed,  that 
nearly  all  of  our  most  flourishing  schools  have 
large  Faculties,  and  lengthened  courses  of  instruc- 
tion, several  extending  their  terms  to  five  months. 
This  fact  is  worthy  of  notice,  as  it  is  due  to  the 
direct  influence  of  the  American  Medical  Associ- 
ation. In  concluding  these  desultory  remarks, 
which  the  opening  of  the  medical  session  has 
suggested,  we  may  add  that  a  careful  observation 
of  the  history  of  our  educational  bodies  for  the 
last  few  years,  reveals  certain  inevitable  tenden- 
cies which  afford  reliable  data  from  which  to 
cast  the  horoscope  of  the  [medical  schools  of  this 
country.  Clinical  instruction  is  to  become  the 
sine  qua  non  in  a  course  of  medical  education,  and 
hence  those  colleges  located  in  populous  towns 
which  abound  in  public  medical  charities,  will 
make  the  strongest  appeal  to  students,  and  gain 
the  largest  classes.  Those  cities,  again,  which 
offer  to  the  schools  the  largest  advantages  for 
hospital  practice,  will  become  inevitably  the 
centres  of  medical  education.  Nor  is  it  difficult, 
in  the  light  of  the  above  facts,  to  indicate  the 
cities  which  are  to  be  crowned  with  this  proud 
distinction.  That  different  sections  of  our  wide 
extended  republic  must  have  their  own  schools  of 


28       RECRUITS  FOR  THE  PROFESSION. 

medicine,  in  which  the  differences  of  diseases  de- 
pendent upon  climate  are  to  be  especially  taught, 
is  evident.  The  North  must  have  her  own  schools, 
and  the  South  and  West  must  have  theirs.  Al- 
ready the  Pacific  coast  constitutes  a  fourth  cli- 
matic division  which  must  have  its  schools.  The 
great  emporia  of  these  grand  divisions  of  the 
country  must  become  the  centres  alike  of  com- 
merce and  education.  We  trust  the  day  is  not 
distant  when  the  schools  of  the  country,  which 
from  their  location  can  not  give  clinical  instruc- 
tion, will  be  abandoned.  They  are  in  every  re- 
spect a  great  obstacle  to  thorough  education. 
Even  if  they  did  not  have  the  power  of  granting 
diplomas,  but  merely  served  to  instruct  the  stu- 
dent in  the  primary  branches,  no  useful  pur- 
pose would  be  gained.  They  are  organized  in 
the  interest  of  a  few  persons  who  have  no  regard 
for  the  true  welfare  of  the  student ;  their  aims  are 
low,  and  the  student  begins  his  studies  at  a  dis- 
advantage which  many  can  not  overcome.  We 
believe  every  medical  student  should  enter  the 
schools  located  in  large  cities,  and  pursue  his 
entire  course  under  the  discipline  which  they 
enforce.  Nor  should  his  diploma  be  granted 
until  he  has  attended  a  systematic  course  of 
clinical  instruction. 


V. 
SUICIDE    IN  THE   TOMBS. 


AYE  All  ago  our  citizens  were  startled  by  the 
occurrence  of  one  of  the  most  public  and 
reckless  murders  in  the  annals  of  crime.  In  the 
latter  part  of  a  summer's  day,  on  Broadway,  at 
an  hour  when  this  great  thoroughfare  is  crowded 
with  pedestrians,  a  gentleman  drew  a  pistol  and 
deliberately  shot  a  lady,  the  ball  taking  effect  in 
the  temple,  and  causing  death  at  the  expiration 
of  several  days.  The  homicide  was  witnessed  by 
hundreds,  and  the  murderer,  arrested  in  the  very 
tracks  when  the  deed  was  committed,  acknowl- 
edged that  the  crime  was  premeditated.  But  to 
go  through  the  farce  of  a  trial,  he  had  to  plead 
the  bitter  falsehood,  "  not  guilty" — a  legal  fiction 
that  has  too  often  thwarted  retributive  justice — 
and  was  accordingly  committed  to  the  Tombs  for 
safe  keeping  to  await  his  trial.  Meantime  his 
counsel  set  earnestly  at  work  to  save  their  client 
from  the  doom  that  seemed  impending,  and  the 
jolly  public,  satisfied  that  in  due  time  it  would  be 
gratified  with  the  details  of  another  execution, 
peered  occasionally  into  the  prisoner's  cell  to  as- 
certain that  the  victim  was  there,  and  thought  no 
more  of  the  matter.     Some  nine  months  after  the 


30  SUICIDE  IN  THE  TOMBS. 

occurrence,  the  morning  papers  announced  that 
this   criminal   had   perpetrated   self-destruction. 
Public  curiosity  was  eager  to  know  by  what  means 
an  inmate  of  that  sepulchral  residence  had  been 
able  to  cheat  the   world  of  another  hangman's 
tale.     One  of  that  quartette  of  coroners  in  which 
this  city  rejoices — ever  vigilant  on  the  scent  of 
blood  but  never  overtaking  the  game— forthwith 
set  to  work  to  unravel  the  mystery.     Attended 
by  a  jury  of  his  countrymen,  resident  in  that  de- 
lectable neighborhood,   he   proceeded  with  due 
ceremony  to  view  the  body,  and  determine  by  this 
enlightening  process  the  nature  of  that  peculiar 
visitation  by  which  the  prisoner  had  been  so  un- 
expectedly deprived  of  life.     Whereupon  it  ap- 
peared  that  deceased  had  never  been  satisfied 
with  the  accommodations  furnished  him  by  the 
city,  and  had  long  ago  determined  to  exchange 
them  for  quarters  more  secluded,  and  less  exposed 
to  public  gaze.     To  this  end  he  desired  the  trans- 
migratory  influence  of  a  certain  drug,  and  accord- 
ingly wrote  the  following  recipe  :   "  Strychnine, 
two  shillings  worth,  to  kill  dogs."     This  message 
was  intrusted  to  his  attendant,  with  directions  to 
obtain  the  article  at  a  drug  store.     But  the  faith- 
less servant  thwarted  his  design  by  handing  the 
prescription  to  the  Warden,  and  thus  revealed 
the  secret  purposes  of  his  master.     A  close  watch 
was  now  placed   over  his  cell,  and  every  pre- 
caution taken  to  prevent  the  prisoner's  self-exe- 
cution.    But  intent  on  his  purpose,  and  undaunted 


SUICIDE  IN  THE  TOMBS.  31 

by  his  defeat,  again  the  tenant  of  the  Tombs  is- 
sued his  orders  ;  but  this  time  he  wrote  for  laud- 
anum. The  message  was  again  intrusted  to  his 
servant,  who  so  far  fulfilled  his  wishes  as  to  ob- 
tain from  a  druggist  the  required  potion.  But 
the  conscience  of  the  servant  proved  too  sensitive 
for  his  task,  and  again  he  betrayed  his  trust  by 
handing  the  package  to  the  vigilant  Warden. 
Notwithstanding  the  infidelity  of  the  servant  and 
the  vigilance  of  the  keepers,  the  prisoner  was 
one  day  found  dying  of  narcotism,  and  an  empty 
vial  labelled  McMunn's  Elixir,  concealed  in  his 
room,  revealed  the  cause  of  death.  The  ar- 
dent Coroner  pursued  his  inquiries,  intent  on 
learning  how  the  poison  was  smuggled  into  the 
cell  in  order  that  he  might  fix  the  crime  upon 
some  responsible  agent.  The  Physician  to  the 
Prison  is  naturally  suspected,  but  he  clears  him- 
self by  deposing  that  he  never  gave  deceased  a 
dose  of  opium.  The  keepers  had  all  maintained 
a  vigilant  watch  over  that  particular  cell,  but  had 
never  seen  a  package  passed  surreptitiously 
through  the  grating,  therefore  they  were  free 
from  suspicion.  The  learned  Coroner  summed 
up  this  mass  of  negative  evidence,  and  the  intel- 
ligent jury,  enlightened  as  to  their  duties,  retired, 
and  after  a  short  deliberation  returned  the  fol- 
lowing verdict : 

"The  deceased  came  to  his  death  by  the  administration 
of  creasote  and  a  preparation  of  opium,  taken  for  the  pur- 
pose of  self-destruction.     Further,  the  Jury  would  recom- 


32  SUICIDE  IN  THE  TOMBS. 

mend  the  proper  authorities  to  place  -wire-netting,  similar 
to  that  now  in  use  on  the  lower  corridor,  on  all  the  cell- 
doors  of  the  City  Prison." 

Thus  stands  revealed  the  thrice  disgraceful 
fact,  that  poisons  are  so  freely  sold  in  this  city, 
that  a  criminal  lodged  in  prison  for  safe  keeping 
to  await  his  trial,  can  dictate  to  his  waiter  the 
kind  of  drug  with  which  he  will  rid  himself  of  lif  e, 
and  but  for  the  treachery  of  the  latter  could  ob- 
tain it.  From  the  closely-locked  and  carefully- 
guarded  cell  of  the  murderer  goes  forth  the 
written  order  for  deadly  poisons,  and  in  large 
quantities  ;  the  druggist  into  whose  hands  it  falls, 
with  nimble  fingers  prepares  the  fatal  draught, 
and  asks  not  a  question  as  to  its  destination. 
The  prescription  for  strychnine  would  have  been 
as  quickly  made  up,  and  delivered  at  an  ordinary 
drug  store,  as  that  for  laudanum  ;  though  had  the 
druggist  paused  and  considered  the  purport  of 
either,  he  would  have  read  in  as  unmistakable 
characters  as  was  written  "to  kill  dogs,"  these 
terrible  words,  "to  kill  a  man!"  The  remedy 
suggested  in  the  verdict  can  by  no  means  reach 
the  evil.  Vain  are  bolts  and  bars,  wire-netting 
and  vigilant  sentinels,  when  the  inmate  of  the 
Tombs  determines  upon  self-destruction.  He 
may  not  be  able  to  accomplish  the  deed  with 
knife,  or  razor,  or  hemp,  but  while  druggists  sell 
poisons  as  a  common  article  of  trade,  the  weapons 
of  the  suicide  are  at  his  command.  No  degree  of 
vigilance  or  precaution  on  the  part  of  keepers 


SUICIDE  IN  THE  TOMBS.  33 

can  prevent  his  access  to  them ;  no  wire-netting 
is  so  strong  or  so  close  that  they  will  not  be  clan- 
destinely placed    within   his   grasp.     If  human 
hands  can  not  convey  them  to  him,  "  some  bird 
of  air"  will  be  the  messenger.     If  that  Jury  had 
done  its  duty,  it  would  have  gone  directly  to  the 
source  from  which  this  class  of  crimes  proceed. 
The  druggist  who  sold  the  laudanum  should  have 
been  charged  with  the  violation  of  the  law  to  reg- 
ulate the  sale  of  poisons,  and  properly  proceeded 
against.     Though  the  parties  to  this  individual 
crime  may  not  have  been  discovered,  the  true  re- 
sponsibility should  have  been  fixed  where  it  be- 
longs, viz.  upon  the  druggists  who  still  continue 
to   sell  poisons,   regardless   of  the   law   or  the 
consequences  of  their  acts.     We  know  of  no  more 
needed  reform  than  that  which  would  forever 
prevent  the  sale  of  drugs  as  common  articles  of 
trade.     Druggists  of  the  character  and  qualifica- 
tion of  those  who  dispense  drugs  in  this  city,  can 
not  be  relied  upon  to  faithfully  execute  any  mere 
rule   or  regulation.      There   must  not   only  be 
stringent  laws  regulating  the  sale  of  drugs,  but 
these  laws  must  be  rigidly  enforced. 


VI. 
NOSTRUM    ADVERTISING. 


|NE  of  the  religious  papers  of  New  York,  a 
few  weeks  ago,  took  to  task  a  secular  paper 
which  claims  to  stand  upon  "  great  primal  Chris- 
tian {ruths,"  for  presuming,  with  such  professions, 
to  admit  into  its  advertising  columns  theatrical 
advertisements,  whereby  "  the  homes  of  Christian 
families"  would  be  demoralized.  It  concluded  its 
rebuke  as  follows : 

''  Now,  if  theatrical  advertisements  must  go  to  the  homes 
of  Christian  families,  we  say,  let  them  be  taken  there  simply 
as  theatrical  advertisements,  and  not  by  a  messenger  who 
professes  to  stand  upon  '  great  primal  Christian  truths'  in 
their  distribution.  We  can  not  think  that  '  the  time  has 
come  for  a  living  Christianity'  thus  '  to  assert  itself.'" 

Presuming,  from  the  confident  tone  of  the 
editor,  that  his  advertising  sheet  must  be  a  model 
for  a  religious  journal  designed  for  the  homes  of 
Christian  families,  we  glanced  down  its  columns, 
and  what  was  our  amazement  to  find  them 
crowded,  not  with  notices  of  theatres,  the  least 
dangerous  of  all  possible  advertisements  to  the 
morals  of  families,  but  with  the  most  disgusting 
and  demoralizing  notices  of  diseases,  and  the 
quack  preparations  adapted  to  them.     Here  is 


NOSTRUM  ADVERTISING.  35 

"  Dalley's  Magical  Pain  Extractor"  which  is  ad- 
vertised to  prevent  and  cure  (in  a  list  of  thirty- 
eight  different  diseases),  small-pox  and  cancer. 
Can  the  Editor  plead  ignorance  of  the  utter  and 
malicious  falsity  of  this  statement  ?  Does  he  use 
Dalley's  Pain  Extractor  to  protect  his  own  chil- 
dren from  small-pox,  or  would  he  recommend  a 
friend  to  try  it  ?  And  yet  he  is  willing  to  lend 
the  pages  of  his  professedly  religious  paper  to  in- 
troduce this  bitter  falsehood  into  "  the  homes  of 
Christian  families."  And  this  paper  the  cunning 
charlatan  selects  because  it  is  a  messenger  who 
professes  to  stand  upon  "  great  primal  Christian 
truths"  in  the  distribution  of  its  advertisements. 
In  an  adjoining  column  of  the  same  paper,  under 
the  startling  title,  "  Health  of  American  Women," 
appears  the  announcement  of  the  Grsefenberg 
Company,  which  we  never  fail  to  find  in  a  paper 
professing  to  stand  upon  "  great  primal  Christian 
truths"  in  the  distribution  of  its  advertisements. 
Is  the  Editor  aware  of  the  nature  of  the  Grasfen- 
berg  Marshall's  Uterine  Catholicon  ?  Does  he 
recommend  it  in  his  own  family  ?  Nay,  dare  he 
read  that  advertisement  at  his  own  fireside  ?  We 
believe  not.  Again,  we  have  Mrs.  Winslow's 
Soothing  Syrup  for  Children  Teething."  The 
advertisement  says,  very  truly,  "  Depend  upon  it, 
mothers,  it  will  give  rest  to  yourselves  and  relief 
to  your  infants."  Thousands  of  mothers  in  this 
city  are  annually  relieved  of  all  further  care  of 
their    infants    through  the   magically   soothing 


36  NOSTRUM  ADVERTISING. 

effects  of  Mrs.  Winslow's  syrup,  which  the  re- 
ligious papers,  as  messengers  who  profess  to 
stand  upon  "  great  primal  truths  in  their  distribu- 
tion," introduce  to  the  homes  and  confidence  of 
Christian  families.  We  commend  to  the  careful 
reflection  of  the  Editor  the  following  extract  from 
the  City  Inspector's  last  report,  in  regard  to 
patent  medicines  and  their  effects  upon  the  mor- 
tality of  children  : 

"  A  very  large  number  of  children  are  killed  annually,  in 
this  city,  by  patent  medicines.  They  are  exhibited  without 
'any  knowledge  of  their  properties,  or  their  power  to  allay 
the  symptoms  for  which  they  are  given.  I  ask,  how  many 
hundred  infants  are  destroyed  by  the  various  vermifuges 
alone  that  are  advertised  ? — given  to  them  with  the  idea 
that  they  are  affected  with  worms,  when,  in  reality,  noth- 
ing of  the  kind  exists  in  a  large  majority  of  cases.  The 
symptoms  that  are  taken  to  be  indicative  of  worms  are 
often  those  of  teething,  or  the  incipient  stages  of  hydro- 
cephalus or  tabes-mesenterica,  etc.,  which,  by  judicious 
treatment,  might  be  cured.  These  nostrums  never  fail  to 
coincide  with  the  disease  and  aggravate  the  symptoms." 

Editors  of  religious  papers  should  ponder  this 
statement,  and  estimate  how  many  of  the  15,000 
children  who  died  last  year  in  this  city  are 
chargeable  to  their  account  ?  We  do  not  desire  to 
be  hypercritical  in  these  remarks  ;  our  only  pur- 
pose is  to  call  the  attention  of  religious  journals 
to  the  fearful  responsibility  which  they  assume 
when  they  prostitute  their  columns  toward  the 
furtherance  of  the  low,  vulgar,  and  immoral  ob- 
jects of  advertisers  of  nostrums.     They  well  know 


NOSTRUM  ADVERTISING.  37 

that  this  class  of  persons  especially  seek  the  col- 
umns of  religious  papers,  because  their  malicious 
falsehoods  are  thus  clothed  with  a  certain  re- 
spectability, and  are  received  by  Christian  fam- 
ilies as  indorsed  by  the  paper  in  which  they 
appear.  But  however  desirable  it  may  be  to 
have  a  reform  in  this  regard,  we  shall  not  see  the 
day  when  religious  principles  will  so  far  triumph 
over  the  power  of  money,  as  to  make  professing 
Christians,  in  the  daily  walks  of  business,  reject 
with  scorn  the  latter,  to  save  untarnished  the 
former.  The  character  of  the  advertisements 
which  fill  the  religious  papers  would  justify  the 
belief  that  the  only  question  which  proprietors 
ask  of  advertisers  is,  "How  much  will  you  pay?" 
We  submit  to  this  and  all  religious  papers  the 
following  advice  :  "  Now,  if  quack  advertisements 
must  go  to  ilie  homes  of  Christian  families,  we  say,  let 
them  be  taken  there  as  quack  advertisements,  and  not 
by  a  messenger  who  professes  to  stand  upon  '  great 
primal  Christian  truths'  in  their  distribution.  We 
can  not  think  that  '  tlie  time  has  come  for  a  living 
Christianity'  thus  '  to  assert  itself  " 


VII. 
PAST    AND    PEESENT. 


THAT  we  have  fallen  upon  evil  times  seems 
to  be  the  settled  conviction  of  some  of  our 
medical  brethren.  We  never  fail,  when  we  meet 
them,  to  be  entertained  with  their  repinings  at 
the  low  state  of  medicine  in  these  degenerate 
times  and  the  consequent  prevalence  of  empiri- 
cism. Some  of  our  older  physicians,  of  this  class, 
have  been  heard  uttering  pious  benedictions  upon 
the  early  communities  in  which  they  practised 
their  profession,  and  predicting  for  the  rising 
generation  of  medical  men,  lives  of  unrequited 
toil,  and  life-long  contentions  with  the  evil  genius 
of  medicine.  A  veteran  practitioner  was  lately 
bemoaning  the  unwillingness  of  his  patients  to 
submit  to  bloodletting,  and  attributed  this  fatal 
prejudice  to  the  influence  of  the  prevalent  systems 
of  quackery.  Another,  in  the  meridian  of  life, 
ambitious  of  a  wide  consultation  business,  with 
many  a  vain  regret,  deplored  the  strict  rule  of 
ethics  which  debarred  him  from  cropping  in  the 
flowery  fields  of  illegitimate  practice.  A  third, 
encountering  in  his  families  the  baneful  influences 
of  unbelief,  was  half  tempted  to  become  every- 
tlring  to  every  one,  to  retain  and  extend  his  busi- 


PAST  AND  PEESENT.  39 

ness.  We  think,  indeed,  that  many  a  one  is  led, 
at  times,  to  believe  that  our  age  is  about  the  most 
trying  upon  which  he  could  have  fallen.  He 
sighs  involuntarily  for  a  return  of  that  period 
when  the  good  physician  was  held  in  equal  vene- 
ration with  the  Gods.  It  natters  his  professional 
pride,  galled  and  chafed  by  daily  contact  with  the 
rude  and  inappreciative  age  in  which  he  lives,  to 
recall  the  language  of  inspired  wisdom  :  "  Honor 
the  physician^with  the  honor  due  unto  him,  for 
the  most  high  hath  created  him  because  of  neces- 
sity. *  *  *  Give  place  and  honor  to  the  phy- 
sician, for  God  hath  created  him  ;  let  him  not  go 
from  thee,  for  thou  hast  need  of  him."  How  his 
heart  warms  toward  Herophilus,  who  called  phy- 
sicians, "  The  hands  of  the  Gods  ;"  and  how  he 
honors  the  great  Homer,  who  affirmed  "  That  one 
physician  is  far  more  worthy  than  many  other 
men."  He  regrets  that  his  lines  had  not  fallen  in 
the  pleasant  places  of  the  past — among  the  intel- 
ligent Abclerians  of  whom  it  is  said,  when  Hip- 
pocrates came  to  their  city  to  cure  Democritus  of 
his  madness,  not  only  the  men,  but  also  the  women 
and  children,  and  people  of  every  age,  sex,  and 
rank,  went  forth  to  meet  him,  giving  him,  with  a 
common  consent,  and  loud  voice,  the  title  of  tute- 
lary deity  and  father  of  their  country  ;  or  among 
the  Athenians  who  celebrated  plays  to  his  honor, 
and  placed  upon  his  head  a  crown  of  gold,  and 
finally  erected  his  statue  for  a  perpetual  monu- 
ment of  his  piety  and  learning.     He  will  note 


40  PAST  AND  PKESENT. 

many  other  periods  in  the  history  of  medicine 
when  it  would  seem  far  happier  to  have  lived 
than  at  the  present ;  when  physicians  appear  to 
have  been  held  in  higher  public  estimation,  and 
empiricism  had  far  less  influence.  But  the  stu- 
dent of  history,  who  penetrates  beneath  the  sur- 
face of  events,  with  due  discrimination  contrast- 
ing the  spirit  of  the  past  with  that  of  the  present, 
finds  much  to  commend  the  latter  to  his  esteem, 
and  to  nerve  him  to  greater  effort  and  vigilance. 
He  learns  that  the  grossest  forms  of  quackery 
prevailed  universally  among  the  people  of  the 
past,  and  that  Hippocrates,  Galen,  Pare,  and 
others,  had  to  contend,  life-long,  against  its  wide- 
spread popular  influence.  He  learns,  too,  that 
all  the  great  names  which  adorn  the  history  of 
medicine  derive  their  chief  lustre  from  lives  of 
probity,  self-sacrifice,  and  devotion  to  the  highest 
interests  of  their  profession.  In  vain  he  searches 
for  evidence  that  they  ever  made  their  profession 
subservient  to  the  interests  of  worldly  honor  or 
gain ;  or  by  evil  associations,  directly  or  impliedly, 
recognized  charlatanry  in  any  form.  To  such  a 
student  these  are  the  repinings  of  selfish  or  shal- 
low men,  who  pursue  their  profession  from  motives 
the  most  grovelling  and  unworthy.  The  present 
has  its  trials,  as  had  the  past ;  but  it  will  require 
little  penetration  to  discover  that  the  degeneracy 
of  our  times  does  not  show  itself  so  much  in  the 
prevalence  of  empiricism  or  the  credulity  of  the 
people,  as  in  the  ignorance,  the  cupidity,  and  the 


PAST  AND  PRESENT.  41 

low,  selfish  aims  of  regularly  educated  medical 
men.  "  Medicine,"  says  Hippocrates,  "  is  of  all 
the  arts  the  most  noble  ;  but  owing  to  the  igno- 
rance of  those  who  practise  it,  and  of  those  who 
inconsiderately  form  a  judgment  of  these,  it  is  at 
present  far  behind  all  other  arts."  A  remark 
more  pertinent  to  our  own  times  could  not  well 
have  been  made.  The  venerable  physician  who 
condemns  his  patient's  aversion  to  his  favorite 
operation  of  phlebotomy,  has  lived  to  see  the  pa- 
tient become  wiser  than  himself.  It  is  not  a 
change  in  public  sentiment  that  renders  the  prac- 
titioner of  to-day  less  successful  in  gaining  the 
confidence  of  his  families  than  formerly,  but  it  is 
the  rust  that  he  has  allowed  to  accumulate  upon 
his  knowledge,  which  the  intelligent  communities 
of  our  time  readily  discover.  We  have  mentioned 
cupidity  as  one  of  the  sins  of  medical  men,  which 
tends  to  abase  medicine.  We  believe  it  is  the 
most  damning  evil  of  the  profession  of  our  times. 
It  is  not  only  the  grand  obstacle  to  the  constant 
acquisition  of  knowledge,  which  should  character- 
ize the  true  physician,  but  it  leads  him  into  evil 
practices  and  unprofessional  associations,  which 
degrade  his  profession  to  a  level  with  that  of  the 
merest  trade.  The  wild  rush  of  medical  men  for 
business,  the  arts  by  which  they  often  obtain  it, 
and  the  desperation  of  the  less  successful,  are 
most  humiliating  to  witness.  It  is  not  to  be  de- 
nied, and  we  make  the  confession  with  shame, 
that  there  are  practitioners  among  us,  holding 


42  PAST  AND  PRESENT. 

important  medical  positions,  who  give  profefc 
sional  advice  to  irregular  practitioners,  simply 
to  gain  the  paltry  fees  which  accrue  from  such 
associations.  Many  weak  and  timid  men  are  led 
by  these  examples  to  disregard  the  high  obliga- 
tions of  their  calling,  and,  allured  by  the  vaunted 
popular  estimation  of  the  various  forms  of  em- 
piricism, to  seek  its  flattering  rewards  ;  they  soon 
become  indifferent  to  their  shame  and  disgrace, 
and  are  lost  to  our  profession.  Such  are  some  of 
the  causes  of  the  evil  times  upon  which  we  are 
thought  to  have  fallen,  and  of  which  we  hear  such 
frequent  complaints.  The  remedy,  like  the  evil, 
is  in  the  profession  itself.  The  hue  between  the 
true  and  false,  the  honest  and  the  dishonest,  can 
not  be  too  strictly  drawn,  nor  too  rigidly  main- 
tained. Let  the  profession  not  only  eschew  all 
alliance  with  empiricism,  but  reject  from  its  fel- 
lowship all  who  countenance  or  abet  irregular 
practice.  Let  it  purge  itself  of  these  unworthy 
members,  these  perpetual  croakers,  whose  in- 
stincts lead  them  to  quackery,  and  who  are  with- 
held from  its  full  embrace  only  by  the  desire  to 
maintain  a  certain  degree  of  respectability.  Then 
will  the  greatest  obstacle  to  the  triumph  of  legiti- 
mate medicine  be  removed,  and  we  may  hail  the 
epoch  of  the  "  good  time  coming." 


VIII. 
PREVENTION  OF  CRIME. 


DURING  the  past  year  one  hundred  and 
sixteen  citizens  of  New  York  City  died  by 
the  hand  of  violence.  Of  this  large  number,  59 
are  recorded  as  homicides,  and  57  as  suicides. 
The  problem  of  the  prevention  of  crime  has 
taxed  the  genius  of  the  wisest  statesmen  and  the 
most  experienced  philanthropists.  To  this  end 
the  penitentiary,  the  prison,  the  rack,  and  the 
gallows  have  been  established,  but  as  yet  without 
avail  in  completely  restraining  the  vicious.  With 
reference  to  homicide  this  question  presents  two 
phases  :  1st,  The  removal  of  the  causes  of  crime  ; 
2d,  The  punishment  of  the  criminal.  It  will  sur- 
prise no  one  to  learn  that  on  investigation  it  ap- 
pears that  in  the  great  majority  of  cases  of  homi- 
cide, intemperance  is  the  cause.  In  this  city,  so 
distinguished  for  its  "rum  for  the  million,"  it 
supplies  the  animus  to  the  criminal,  however 
thoroughly  his  plans  are  premeditated,  in  nine 
cases  out  of  ten.  This  fact  is  so  patent  to  every 
observer  that  it  needs  no  illustration  at  our  hands. 
But  one  plain,  simple,  practical  question  presents 
itself  to  the  legislator,  viz.  shall  this  prolific  cause 
of  the  most  heinous  crime  known  to  human  so- 


44  PKEVENTTON  OF  CKIME. 

ciety,  be  removed  ?  On  the  answer  to  this  ques- 
tion depends  the  length  of  our  criminal  calendar. 
We  are  aware  that  many  difficulties  tend  to  com- 
plicate its  settlement  in  the  affirmative,  but  we 
are  also  aware  that  these  obstacles  have  been  met 
by  other  communities,  and  resolutely  overcome. 
The  results  of  such  legislation  have  always  been 
of  the  most  cheering  character.  Penitentiaries, 
prisons,  and  almshouses  have  been  deprived  of 
their  occupants,  and  even  courts  have  met  to  ad- 
journ without  a  cause  upon  their  criminal  calen- 
dar. No  man  can  doubt  that  if  during  the  year 
upon  which  we  have  entered,  not  a  drop  of  spiritu- 
ous liquor  was  drunk  by  the  people  of  this  city, 
our  almshouses,  hospitals,  and  prisons  would  be 
emptied  of  nine-tenths  of  their  present  number  of 
inmates,  and  our  criminal  statistics  for  the  year 
would  be  reduced  99  per  cent.  Again,  insane 
persons,  with  depraved  and  dangerous  propen- 
sities, are  so  frequently  permitted  to  roam  unre- 
strained about  our  streets,  that  we  are  prepared 
to  witness  tragedies  the^most  horrible  and  sudden 
at  any  time  and'  in  any  place.  On  the  7th  of 
December  last,  this  city  was  thrown  into  a  fever 
of  excitement  at  the  report  of  the  shocking  mur- 
der of  Mrs.  Shanks,  a  worthy  seamstress  and 
shopkeeper,  while  at  her  breakfast  in  the  parlor 
adjacent  to  her  store.  This  fiendish  act  was  per- 
petrated in  an  open  apartment  on  a  busy  street, 
within  a  few  steps  of  Broadway  and  Union 
Square.     The  murderer  was  a  lad  well  known  in 


PREVENTION  OF  CKIME.  _   45 

that  neighborhood  as  a  strange  and  sullen  fellow, 
and  in  the  criminal  courts  he  was  recognised  as  a 
person  of  unsound  mind  and  uncontrolled  propen- 
sities to  commit  crimes  against  property  and  life. 
To  the  police  he  was  known  as  an  epileptic  whom 
they  often  rescued  from  harm  when  suffering  his 
unfortunate  seizures  in  the  streets.  He  some- 
times had  as  many  as  twenty-five  of  these  fits  in 
a  single  day,  and  his  mind  was  so  affected  that 
his  parents  could  do  nothing  with  him.  After 
having  been  four  months  in  a  Lunatic  Asylum  he 
was  permitted  to  return  to  his  parents'  home  and 
go  at  large  in  the  city.  Having  at  one  time  set 
fire  to  some  shops  and  a  public  school-house,  he 
was  judged  guilty  by  the  prosecuting  officer,  but 
allowed  to  go  unrestrained  upon  condition  his 
parents  would  remove  him  from  the  city !  And 
now,  at  last,  this  miserable  young  man,  after  such 
a  career  and  such  unmistakable  evidence  of  men- 
tal and  moral  insanity  from  a  well-known  physical 
disease,  yields  to  his  fiendish  impulses  and  bru- 
tally murders  a  kind-hearted  lady  who  has  pre- 
viously shown  him  peculiar  kindness.  The  deed 
was  manifestly  an  impulsive  one,  for  strolling  into 
the  little  store,  and  seeing  the  woman  at  her 
breakfast,  he  seized  the  knife  with  which  she  was 
cutting  a  loaf,  and  instantly  cut  her  throat  from 
ear  to  ear.  After  the  deed  he  was  shy  and  fear- 
ful, and  started  upon  an  emigrant  train  for  the 
"West.  Being  arrested  and  returned  he  attempts 
to  cover  and  deny  his  crime,  as  a  sane  man  would 


46  PEEVENTION  OF  CHIME. 

do,  and  as  a  lunatic  might,  but  without  success. 
The  fact  of  his  insanity  had  been  as  clearly  estab- 
lished before  as  it  has  been  since  the  murder ; 
and  his  dangerous  proclivities  were  known.  The 
prosecuting  officer  at  first  declined  to  admit  the 
plea  of  insanity;  but  after  considerately  hear- 
ing the  simple  story  of  the  lad's  physical  and 
mental  disorders,  he  promptly  ordered  him  to 
the  State  Lunatic  Asylum.  In  the  correction  of 
criminals,  the  first  impulse  of  government  was 
to  appeal  to  the  fears  of  men,  and  hence  have 
been  instituted  the  most  frightful  punishments. 
While  the  more  simple  offences  growing  out 
of  avarice  and  kindred  propensities  were  thus 
checked,  the  more  heinous  crimes,  which  are 
the  result  of  violent  and  intensely  stimulated 
passion,  received  but  little  restraint.  Subse- 
quently a  more  philosophical  study  of  crimi- 
nal jurisprudence  discovered  the  fact  that  vicious 
men  are  restrained  rather  by  the  certainty,  than 
the  severity  of  punishment.  This  led  to  impor- 
tant discriminations  in  the  degrees  of  crime,  and 
corresponding  modifications  in  the  severity  of 
the  penalties,  and  should  never  be  lost  sight  of 
in  legislation  for  the  suppression  of  crime.  But 
with  the  progress  of  human  knowledge  and 
practical  Christian  philanthropy,  new  opinions 
have  been  formed  of  man's  moral  nature,  and 
of  his  relations  to  his  Creator  and  his  fellow- 
men,  which  are  yet  to  lead  to  the  most  important 
modifications  of  our  criminal  laws.     The  question 


PKEVENTION  OF  CRIME.  w  47 

should  not  all  punishments  be  so  modified  as  to 
be  reformatory  of  tlie  individual  ?  is  already  re- 
ceiving a  practical  solution  in  many  States.  The 
final  prevalence  of  the  conviction,  that  the  period 
of  restraint  of  the  criminal  should  be  taken  ad- 
vantage of  by  the  State  for  his  reformation,  that 
he  may  be  returned  to  society  a  good  citizen,  will 
be  the  grandest  triumph  of  a  Christian  civiliza- 
tion. The  prevention  of  suicide  involves  also  two 
points,  viz.  1st,  The  removal  of  its  causes  ;  2d, 
The  removal  of  the  means  by  which  it  is  accom- 
plished. The  alleged  causes  of  suicide  are 
numerous.  They  are  insanity,  intemperance, 
melancholy,  disappointment,  revenge,  etc.  If, 
however,  each  case  were  carefully  investigated, 
we  doubt  not  these  causes  with  due  discrimina- 
tion might,  for  the  most  part,  be  reduced  to  one, 
viz.  insanity.  The  researches  in  psychological 
medicine  have  established  the  fact  that  insanity 
lurks  in  the  community  in  concealed  forms,  while 
all  are  cognizant  of  its  sudden  development  in 
the  perpetration  of  shocking  crimes.  There  can 
be  no  doubt  that  many  who  are  actively  engaged 
in  business,  or  walk  the  streets,  or  mingle  in 
society,  have  those  mental  proclivities  which  the 
most  trifling  perturbating  causes  would  so  un- 
balance as  to  lead  to  personal  violence.  Most 
physicians  can  recall  instances  of  the  self-destruc- 
tion of  persons,  who,  on  reflection,  they  recollect 
have  exhibited  many  singular  peculiarities  to 
which  they  did  not  attach  sufficient  importance. 


48  PREVENTION  OF  CRIME. 

Toward  this  class  of  suicides  our  profession  has 
a  most  important  duty  to  perform.  We  should 
be  more  thorough  in  the  investigation  of  the 
secret  springs  of  melancholy,  disappointment,  or 
other  disturbing  influences  of  the  mind  and  pas- 
sions, and  so  far  as  possible  remove  them.  The 
physician  alone  can  frequently  recognize  those 
early  deviations  of  the  mind  from  the  standard 
normal  to  the  individual,  which  give  timely  in- 
dications of  approaching  danger.  And  he  alone 
can  discover  the  causes  at  work,  and  the  physical 
conditions  induced,  and  suggest  the  required 
remedial  measures.  The  remedy  is  often  extremely 
simple,  and  perfectly  averts  the  impending  evil,  if 
it  is  thoroughly  and  judiciously  applied.  If 
remedies  do  not  succeed,  and  the  case  progresses 
unfavorably,  it  is  the  duty  of  the  physician  to  se- 
cure the  patient's  restraint  or  control  to  the  ex- 
tent necessary  to  prevent  the  terrible  crimes  of 
homicide  and  suicide  now  so  frequent.  Not  only 
must  the  community  at  large,  and  families  which 
unconsciously  retain  in  their  unprotected  circle 
a  member  who  at  any  moment  may  commit  the 
most  horrible  acts,  depend  upon  our  profession 
for  the  discrimination  of  this  class  ;  but  the  poor, 
misunderstood,  and  often  maltreated  victim  of 
mental  alienation,  equally  appeals  to  us  for  that 
protection,  consideration,  and  care  which  he  can 
secure  from  no  other  earthly  source. 


IX. 
CAEE    OF    INFANTS. 


SOME  weeks  since  we  received  a  communica- 
tion from  an  English  correspondent  who 
has  given  much  attention  to  the  subject  of  wet- 
nursing  in  its  bearings  upon  the  public  health. 
From  this  source  we  learn  that  at  the  Interna- 
tional Statistical  Congress,  held  in  London  last 
year,  Dr.  Edwaed  Jarvts,  a  delegate  from  Massa- 
chusetts, in  the  discussion  which  followed  the 
reading  of  a  paper  on  the  Statistics  of  Wet- 
Nursing,  remarked  that  in  the  United  States 
"  the  employment  of  a  wet-nurse  is  very  rarely 
resorted  to ;  indeed,  the  custom  is  almost  un- 
known there."  This  statement  seems  to  have  ex- 
cited great  interest,  and  has  been  the  subject  of 
much  comment.  Coming  from  a  responsible 
source  it  has  been  received  as  authoritative,  and 
has  afforded  good  ground  for  the  supposition 
that  wet-nursing  is  by  no  means  as  necessary  as 
the  ladies  of  England  seem  to  consider.  We  do 
not  know  the  source  of  Dr.  Jarvis'  information, 
nor  on  what  investigations  his  conclusions  were 
based.  They  should  certainly  have  been  arrived 
at  only  after  extended  inquiry,  especially  in  our 
large  cities,  as,  uttered  in  that  high  presence, 
3 


50  CAEE  OF  INFANTS. 

they  could  not  but  have  an  important  influence 
upon  the  discussions  which  followed  the  reading 
of  the  paper  mentioned.  Nor  has  their  influence 
ceased  with  the  adjournment  of  the  Statistical 
Congress,  but  we  now  learn  that  subsequent 
writers  have  alluded  to  them  as  conclusive  on 
the  subject  of  wet-nursing.  Although  we  are  not 
prepared  to  give  statistical  data,  yet  the  results 
of  extensive  observation  authorize  us  to  state  that 
wet-nursing  is  far  from  being  unknown  in  New 
York  city.  On  the  contrary,  it  may  be  considered 
a  very  prevalent  custom,  supported  alike  by  ne- 
cessity and  fashion.  Whoever  will  consult  the 
columns  of  "  Wants"  in  our  daily  papers  will  soon 
become  satisfied  of  the  existence  of  this  practice 
in  our  community,  though  it  is  not  possible  to 
obtain  a  knowledge  of  its  extent  from  that  source. 
To  gain  more  accurate  information  of  the  amount 
of  wet-nursing  requires  familiarity  with  the  lying- 
in  departments  of  our  public  charities,  and  with 
the  poor  and  unfortunate  in  then  homes.  Ex- 
tended inquiry  of  those  who  have  devoted  much 
time  in  public  institutions,  and  in  dispensary 
practice,  confirms  our  own  observations,  that  wet- 
nurses  always  find  a  demand  for  their  services. 
The  applications  for  wet-nurses  at  our  Lying-in 
Institutions  often,  indeed,  greatly  exceed  the  sup- 
ply. There  can  be  no  doubt,  therefore,  that  wet- 
nursing  is  more  customary  than  Dr.  Jarvis  would 
believe.  The  practice  of  wet-nursing  grows  out 
of :  1st,  The  inability  of  the  mother  to  discharge 


CAEE  OF  INFANTS.  51 

her  maternal  duties  ;  and,  2d,  Either  false  pride, 
or  an  indisposition  to  be  burdened  with  the  care 
of  her  offspring.  Both  of  these  conditions  exist 
in  this,  as  in  all  large  cities,  and  we  are  not  a 
little  surprised  that  an  educated  physician  should 
have  failed  to  recognize  them.  The  first  unques- 
tionably renders  the  practice,  to  a  limited  extent, 
a  necessity ;  the  second  springs  from  that  social 
refinement  which  sets  at  naught  all  natural  laws, 
and  renders  life,  as  far  as  possible,  entirely  arti- 
ficial. The  former  of  these  causes,  we  are  in- 
clined to  believe,  leads  to  the  employment  of  the 
wet-nurse  in  the  majority  of  instances  in  this 
community,  though  the  latter  exerts  an  influence 
to  no  inconsiderable  extent.  We  have  before  us 
a  paper  on  "  The  Practice  of  Hiring  Wet-Nurses 
considered  as  it  affects  Public  Health  and  Public 
Morals,"  which  was  presented  to  the  "  National 
Association  for  the  Promotion  of  Social  Science," 
England,  hi  1859,  byM.  L.  Baines.  The  evils  of 
wet-nursing  are  here  presented  in  a  two-fold  light : 
1st,  moral  and  social;  and  2d,  physical.  The 
former  grow  out  of  the  employment  of  fallen 
women,  a  practice  urged  by  a  class  of  philan- 
thropists, but  which  can  not  be  too  severely  con- 
demned, not  only  on  account  of  its  immoral  ten- 
dencies, but  also  of  the  physical  evils  that  are 
liable  to  be  entailed  upon  the  nurseling  by  the 
imbibition  of  constitutional  proclivities  to  disease. 
The  latter  evils  result  both  to  the  child  of  the 
nurse,  which  is  either  put  out  to  an  inferior  nurse, 


52  CARE  OF  INFANTS. 

or  is  hand-fed ;  and  to  the  child  which  she  as- 
sumes to  nurse,  owing  to  its  deprivation  of  ma- 
ternal milk.     It  is  stated  by  this  writer  that,  "  It 
may  be  fairly  assumed  that  the  children  of  ivet- 
nursesform  a  very  large  proportion  of  those  who  die 
prematurely."     We  are  not  prepared  to  indorse 
this,  as  a  general  statement,  but  we  have  the 
most  undoubted  proof  of  the   great  mortality 
among  foundlings  in  this  city ;  while  they  were 
put  out  to  nurse,  nearly  one-half  died  annually. 
It  appears  also  that  out  of  every  one  hundred 
children    in    Paris,    nursed    by   their   mothers, 
eighteen  die  in  the  first  year,  while  of  those  wet- 
nursed,  twenty -nine  die.     The  practice  of  employ- 
ing wet-nurses,  therefore,  can  but  be  considered 
an  evil,  and  one  which  is  destined  doubtless  to 
increase  in  the  ratio  of  our  increase  in  wealth  and 
luxury.     What  is  the  remedy?     The  entire  re- 
sponsibility of  resisting  its  progress  rests  with 
the  medical  profession.     We  should  endeavor  to 
remove  the  causes  of  the  evil,  by  inducing  mothers 
to  rear  their   own   children  by  the  means  that 
nature  has  given  them.     The  arguments  which 
may  be  employed  are  too  strong  to  be  resisted,  if 
kindly,  conscientiously,  and  firmly  presented  by 
the  medical  attendant.     If  this  duty  were  thor- 
oughly discharged,  in  every  instance,  the  system 
of  wet-nursing  would  at  once  fall  into  disrepute, 
and  the   custom  would  truly  become  what  Dr. 
Jarvis  represented  it,  "  almost  unknown"  in  this 
country.     In  the  comparatively  few  cases  where 


CARE  OF  INFANTS.  53 

the  mother  is  absolutely  disqualified,  it  is  still  a 
question  if  artificial  lactation,  in  the  hands  of  a 
competent  nurse,  might  not  be  preferable  to  wet- 
nursing.  But  admitting  that  the  wet-nurse  must 
be  obtained,  the  physician  is  still  the  adviser,  and 
has  it  in  his  power  to  make  the  selection.  And 
here  occurs  an  important  duty,  which  is  almost 
invariably  overlooked ;  if  the  wet-nurse  has  a 
child  of  her  own,  it  is  liable  to  be  put  aside  with- 
out a  care,  or  even  thought,  on  the  part  of  the 
employer.  The  physician  should  remember  that, 
in  providing  a  nurse  for  his  patient,  he  is  not  less 
responsible  for  the  life  of  the  helpless  human 
being  which  is  set  aside,  and  should  insist  that  it 
be  properly  provided  for.  It  is  a  most  unjusti- 
fiable and  inhuman  act  to  condemn  an  infant  to 
leave  its  mother  and  run  the  risks  of  bottle  feed- 
ing for  the  sake  of  saving  the  life  of  another. 
No  conscientious  medical  attendant  could  be  a 
silent  partner  to  such  a  crime.  We  have  done 
little  more  than  open  this  subject,  but  if  we  have 
succeeded  in  impressing  upon  even  a  single  phy- 
sician the  importance  of  discharging  a  duty  long 
neglected,  our  purpose  has  been  accomplished. 


X. 
WOMAN    AS    PHYSICIAN. 


ABOUT  twenty  years  ago  the  Faculty  of  a 
Medical  College,  in  an  interior  town,  was 
surprised  by  the  receipt  of  a  letter  from  a  lady 
making  application  for  admission  as  a  medical 
student.  The  application  was  accompanied  by 
testimonials  of  moral  character,  and  proficiency 
in  her  studies,  from  a  medical  man  of  high  stand- 
ing. In  their  extremity  the  faculty  determined 
to  leave  the  question  of  her  admission  to  the  class, 
with  the  avowal  that  if  one  member  dissented, 
the  application  of  the  lady  student  should  be  re- 
fused. A  class  meeting  was  held,  and  influenced 
by  the  novelty  of  the  request,  a  unanimous  ap- 
proval was  unhesitatingly  given.  Several  days 
after,  one  of  the  professors,  on  entering  the  class- 
room, wras  accompanied  by  a  short,  thick-set  young 
lady,  with  features  expressive  of  decision,  resolu- 
tion, and  energy,  who  took  her  seat  upon  the 
first  tier,  and  without  embarrassment  began 
taking  notes  of  the  lecture.  Time  wore  on,  and 
though  the  first  effects  of  the  presence  of  the  lady 
upon  the  class  gradually  passed  away,  still  there 
was  no  time  that  her  appearance  a  few  minutes 
preceding  the  lecturer  would  not  instantly  hush 


WOMAN  AS  PHYSICIAN.  55 

to  perfect  silence  the  most  noisy  and  uproarious 
gathering  of  medical  students  which  we  ever  met. 
She  attended  the  lectures  with  scrupulous  punct- 
uality, and  in  the  public  examinations  "by  the 
professors  proved  herself  as  capable  as  the  best 
qualified  students  in  attendance.  She  was  absent 
but  once  during  the  term,  and  the  occasion  of 
this  delinquency  reflected  creditably  upon  her 
character,  and  gained  for  her  the  admiration  of 
the  class.  At  the  close  of  a  lecture  on  the  anato- 
my of  the  organs  of  generation,  the  professor 
read  a  letter  from  the  lady-student,  who  had  been 
refused  admittance,  administering  a  stern  re- 
buke for  his  refusal  to  allow  her  to  be  present  at 
these  lectures,  expressing  her  determination  to 
attend  the  complete  course,  and  modestly  offering 
to  take  the  highest  seat  in  the  theatre,  and  re- 
move her  bonnet,  if  thereby  he  would  feel  less 
embarrassed.  She  completed  her  course,  and 
graduated  with  honor.  Subsequently  she  visited 
the  hospitals  of  Europe,  and  everywhere  won  the 
respect  of  the  medical  men  whose  acquaintance 
she  made.  On  her  return  to  this  country  she 
commenced  general  practice,  but  failing  of  suc- 
cess she  opened  a  private  hospital,  which  is  now 
in  active  operation,  and  is  doing  good  service 
among  our  medical  institutions.  Since  that 
period  considerable  progress  has  been  made  in 
the  education  of  female  physicians ;  we  have 
chartered  medical  schools  for  females  exclusively, 
and  also  for  males  and  females,  while  public  opin- 


56  WOMAN  AS  PHYSICIAN. 

ion,  of  course,  sets  strongly  in  favor  of  the  medi- 
cal education  of  females.  In  the  medical  profes- 
sion, the  question  has  already  been  mooted,  Shall 
female  physicians  be  recognized?  This  is  a  new 
question  in  medical  ethics,  which  is  not  provided 
for  in  our  national  code.  How  shall  it  be  de- 
cided ?  Shall  we,  or  shall  we  not,  recognize 
properly  educated  female  physicians  as  prac- 
titioners in  good  and  lawful  standing  ?  To  rec- 
ognize them  is  to  encourage  their  study  of  medi- 
cine, and  to  commit  ourselves  to  the  removal  of 
every  obstacle  to  their  education.  It  were  well 
therefore  if  this  question  were  definitely  settled. 
We  have  sketched  above  a  representative  example 
of  a  female  physician.  Let  us  consider  the  sali- 
ent points  which  it  presents ;  and  incidentally 
indicate  the  principal  sphere  of  usefulness  which 
medically  educated  women  are  calculated  to  fill 
with  advantage  to  themselves  and  the  public. 
1st.  The  allegation  of  the  incompetency  of  women 
can  not  be  sustained.  This  lady  was  one  of  the 
best  qualified  of  the  graduating  class,  many  mem- 
bers of  which  have  since  risen  to  positions  of  use- 
fulness and  distinction.  She  persisted  in  her 
resolution  to  attend  the  entire  course  on  anato- 
my, not  from  any  morbid  taste,  but  from  a  firm 
determination  to  make  her  medical  education 
thorough  and  complete.  She  won  the  respect  of 
the  most  learned  of  our  profession  abroad  by  her 
intelligent  zeal  in  the  pursuit  of  her  professional 
studies.     But  we  need  not  discuss  the  question  of 


WOMAN  AS  PHYSICIAN.  57 

woman's  intellectual   abilities   to  cope  with  the 
most  abstruse  questions  in  the  medical  sciences, 
while  the  admirable  works  of  Mesdames  Boivin 
arid  Lachapelle    are  recognized   as   authorities. 
2d.  Nor  could  it  be  alleged  against  her  that  she 
sought  to  pursue  any  irregular  course  of  medi- 
cine.    On  the  contrary,  she  was  in  the  highest 
sense  orthodox ;  and  it  can  not  be  proved  that 
female  physicians  will  be  more  prone  to  quackery 
than  the  opposite  sex,  provided  the  same  educa- 
tional  advantages   are   accorded  to  them.     3d. 
This  lady  physician  engaged  in  general  practice, 
and  though  she  had  the  sympathies  of  a  large 
circle  of  wealthy  and  influential  friends,  as  well 
as  physicians,  she  failed  of  patronage,  and  hence 
of  success.     She  was  found  unable  to  meet  the 
exigencies  of  the  every-day  duties  of  her  profes- 
sion, as  every  one  practically  familiar  with  the 
exacting  nature  of  those  duties  would  have  fore- 
seen.    The  storm,  the  cold,  the  night,  the  dis- 
tance, were  barriers  which  she  could  not  overcome 
without  assuming  the  habits,  dress,  and  manners 
of  the  opposite  sex.     And  often  the  disease  which 
she  encountered  was  of  such  a  nature  as  to  com- 
pel her  either  to  unsex  herself  in  regard  to  her 
instinctive  habit  of  reticence  and  modesty,  or 
preserve  her  feminine  sensibilities  by  neglecting 
her  professional   duty.     4th.  Subsequently    she 
became  the  medical  head  of  a  private  charity  for 
the  treatment  of  sick  women,  in  which  capacity 
her  medical  education  is  admirably  adapted  to 


58  WOMAN  AS  PHYSICIAN. 

develop  and  give  efficiency  to  her  natural  tastes 
and  instincts,  and  thus  render  her  life  one  of 
eminent  usefulness.  In  this  sphere  of  profes- 
sional duty,  we  shall  doubtless  yet  see  woman 
take  a  most  prominent  part.  There  is  scarcely  a 
charity,  having  a  medical  element,  which  she  is 
not  in  many  respects  better  adapted  to  manage 
than  the  opposite  sex.  In  hospitals  and  asylums 
for  her  own  sex,  for  cliildren,  and  for  the  aged, 
she  is  pre-eminently  qualified  to  have  the  entire 
management.  It  is  questionable  also  if  her  quick 
perception,  her  generous  sympathies,  her  kindly 
influences,  and  her  admitted  jurisdiction  over  all 
that  pertains  to  domestic  regulations,  would  not 
peculiarly  qualify  her  for  the  care  and  super- 
intendency  of  lunatic  asylums,  reformatories,  etc., 
if  a  proper  medical  education  were  superadded. 
These  are  but  few  of  the  many  branches  of  medi- 
cal service  which  will  open  inviting  fields  of  labor 
to  those  women  who  are  attracted  to  the  study 
of  medicine.  It  is  idle  to  resist  the  progress  of 
public  opinion  toward  the  largest  liberty  in  the 
education  of  women  for  the  most  active  duties  of 
society,  and  their  free  choice  of,  and  perfect 
equality  in,  such  departments  as  they  may  elect 
to  enter.  It  is  certain  that  medicine,  which  gives 
such  scope  to  the  study  of  the  natural  sciences, 
and  such  development  to  the  higher  sentiments 
and  holier  feelings  in  the  practical  application  of 
its  principles,  will  hereafter  invite  women  to  our 
ranks  in  yearly  increasing  numbers. 


XI. 

FOREIGN    EMIGRATION. 


THE  facilities  for  emigration  from  European 
ports  have  been  largely  increased  within 
a  few  years,  and  it  is  gratifying  to  notice  a  corre- 
sponding improvement  in  the  class  of  persons 
who  are  now  seeking  homes  among  us.  The  pro- 
tection which  our  authorities  now  extend  to  the 
immigrant  immediately  upon  his  arrival,  and  the 
facilities  which  they  afford  him  for  reaching  his 
destination,  should  be  noticed  as  having  an  im- 
portant bearing  upon  his  happiness  and  future 
success.  For  a  long  period  the  immigrant  was 
left  a  prey  to  desperate  bands  of  land-pirates 
who  hovered  about  quarantine.  Ignorant  of  the 
language,  unaccustomed  to  traveling,  unsus- 
picious and  confiding,  the  poor  traveler  would 
readily  fall  into  the  toils  laid  for  him,  and  even 
before  landing  would  often  be  divested  of  every 
farthing  of  his  carefully  preserved  treasure. 
Thus  thousands,  whose  destination  was  the  far 
West,  were  left  destitute  in  our  city,  and  com- 
pelled to  seek  daily  bread  by  any  menial  service. 
Happily  these  outrages  are  now  rarely  perpe- 
trated, and  the  immigrant,  with  his  family  and 
goods,  passes  directly,  rapidly,  and  undisturbed 


00  FOREIGN   EMIGRATION. 

to  his  ulterior  destination.  There  is,  however, 
one  passage  in  the  history  of  the  emigrant  which 
deserves  the  immediate  attention  of  government. 
We  refer  to  the  wholesale  prostitution  of  unpro- 
tected females  on  shipboard  by  the  ship's  crew. 
The  revelation  of  these  crimes,  which  are  fre- 
quently made,  are  discreditable  in  the  highest  de- 
gree to  masters  of  ships,  and  even  to  shipowners. 
If  we  are  not  misinformed,  emigrant  vessels  are 
often  but  floating  brothels.  Government  should 
throw  around  the  emigrants,  during  the  voyage, 
such  safeguards  as  will  protect  them  from  the 
hand  of  violence  and  of  crime  of  every  nature. 
There  are  some  features  in  the  history  of  emigra- 
tion to  this  country  which  we  shall  take  occasion 
to  notice  in  connection  with  the  above  facts. 
Previously  to  September  30,  1819,  no  reliable 
records  of  immigration  were  kept  by  our  govern- 
ment, and  all  computations  of  its  amount  at  any 
given  period  before  that  date  are  conjectural.  It 
is  estimated,  in  round  numbers,  that  from  1754 
to  1819,  150,000  immigrants  landed  on  our  shores. 
After  1819  the  public  records  give  us  reliable 
data  from  which  to  ascertain  the  extent  and 
fluctuation  of  immigration.  It  appears  that  from 
this  date,  to  December  31,  1855,  the  number  of 
alien  emigrants  was  4,212,624.  For  the  first 
year  of  this  period,  ending  September  30,  1820, 
the  number  was  8,385,  the  increase  was  gradual, 
until  1831-2,  when  it  rose  from  22,633  to  53,179. 
From  this  period  the  increase  regularly  continued 


FOREIGN    EMIGRATION.  61 

until  it  reached  in  1842,  104,565.  During  the 
next  two  years,  1843-4,  the  number  again  fell, 
but  from  the  latter  date  to  1854  it  rapidly  in- 
creased until  it  reached  the  enormous  figure  of 
427,833.  In  the  following  year,  1855,  it  fell 
nearly  half,  and  hi  1858,  it  was  but  144,652.  It 
is  estimated  that  the  aggregate  emigration  to 
tins  country  from  1784  to  1859  amounts  to 
5,000,000  persons.  There  are  always  two  circum- 
stances influencing,  if  not  controlling  emigration. 
The  first  is  the  condition  of  the  country  from 
which  emigration  takes  places,  and  the  second 
that  of  the  country  toward  which  it  tends ;  the 
very  act  of  emigration  indeed  presupposes  that 
the  former  is  unfavorable  and  the  latter  favorable 
to  the  prosperity  or  happiness  of  the  emigrating 
classes.  Human  history  is  but  a  panoramic  view 
of  these  shifting  scenes,  each  illustrating  but  dif- 
ferent phases  of  the  same  truth.  In  general,  the 
causes  which  lead  to  the  removal  of  any  con- 
siderable class  from  their  paternal  homes,  spring 
either  from  the  oppressions  of  government  or  the 
hope  and  promise  of  gain.  Proscribed  classes 
have  often  been  forced  to  seek  permanent  abodes 
on  foreign  and  sometimes  inhospitable  shores. 
But  more  frequently  emigration  is  a  voluntary 
act,  determined  by  both  of  these  causes,  viz.  op- 
presion  at  home  and  the  hope  of  gain  by  adven- 
ture. This  is  eminently  true  of  the  emigration 
to  America  from  European  and  other  countries, 
and  the  fact  that  this  tide  has  set  steadily  to  our 


62  FOREIGN   EMIGRATION. 

shores,  from  all  parts  of  the  world,  for  eighty 
years,  with  but  an  occasional  ebb,  proves  con- 
clusively the  adaptation  of  our  soil,  climate,  and 
above  all,  our  free  institutions,  to  promote  the 
happiness  and  prosperity  of  mankind.  The 
sources  of  this  emigration,  and  its  amount  from 
different  countries,  do  not  determine  positively 
the  degree  of  oppression  under  which  an  indi- 
vidual people  labor,  and  the  restraints  to  which 
their  physical  well-being  is  subjected  by  either 
soil,  climate,  or  government,  though  they  must 
approximately.  In  this  view,  it  is  interesting  to 
notice  the  countries  which  have  constituted  the 
aggregate  of  our  alien  population  during  this 
period.  Of  the  5,000,000  immigrants  who  have 
arrived  since  the  establishment  of  our  govern- 
ment, Great  Britain  and  Ireland  contributed 
2,600,000;  Germany,  1,600,000 ;  France,  200,000; 
British  America,  100,000 ;  Sweden  and  Norway, 
50,000;  China,  50,000;  Switzerland,  40,000; 
West  Indies,  36,000  ;  Holland,  18,000  ;  Mexico, 
16,000;  Italy,  8,000;  Belgium,  7,000;  South 
America,  5,500 ;  Portugal,  2,000 ;  Azores,  1,300  ; 
Russia,  1,000.  The  fluctuations  in  emigration 
which  we  have  noticed  have  been  due  to  tem- 
porary causes,  which  have  merely  interrupted  the 
enlarging  current,  or  suddenly  swollen  it  to  an  un- 
precedented degree.  Among  the  first  of  these  we 
notice  the  disturbance  of  the  friendly  relations 
existing  between  our  government  and  those  from 
which  emigration  takes  place,  commercial  crises, 


FOREIGN    EMIGRATION.  63 

etc. ;  and  of  the  latter,  the  chief  are  acts  of  pro- 
scription by  foreign  governments,  the  occurrence 
of  famine,  etc.  The  emigration  to  America,  since 
the  establishment  of  our  government,  considered 
in  any  respect,  whether  political,  social,  or  re- 
ligious, must  be  regarded  as  the  most  remarka- 
ble in  the  history  of  mankind.  For  nearly  a 
century,  from  every  civilized,  and  from  many 
semi-civilized  nations,  the  drift  of  emigration  has 
been  to  our  shores.  The  emigrant  is  generally 
the  poor,  the  disaffected,  or  the  vicious,  who 
seeks  either  to  improve  his  condition,  or  gain  a 
wider  field  for  the  exercise  of  his  hitherto  re- 
strained passions.  Yet  from  this  singular  ad- 
mixture of  races,  religions,  and  diverse  political 
education,  there  has  as  yet  resulted  only  har- 
mony, peace,  prosperity,  civil  and  religious  free- 
dom, and  universal  domestic  happiness.  The 
problems  which  these  now  historical  facts  present 
to  the  speculative  are  numerous,  and  of  remarka- 
ble interest.  The  theoretical  statesman  has  no 
precedent  to  determine  the  future  complexion  of 
our  political  institutions  ;  the  speculative  theo- 
logian can  by  no  process  of  reasoning  or  gen- 
eralization establish  a  national  church  ;  and  the 
ethnologist  is  at  a  loss  as  to  the  final  type  of  an 
American. 


XII. 
WHAT    SHALL    WE    BEAD? 


A  FACETIOUS  Professor  in  one  of  our  med- 
ical schools  is  accustomed  to  give  the 
following  as  his  parting  counsel  to  the  graduat- 
ing class:  "If  you  find  leisure  to  read  during 
your  first  years  of  practice,  select  novels  in  pref- 
erence to  medical  journals."  This  admonition  is 
generally  received  by  the  students  as  one  of  those 
broad  jokes  for  which  its  author  is  so  greatly  dis- 
tinguished, and  is  no  further  heeded.  But  that 
the  advice  is  seriously  given,  is  proved  by  the 
fact  that  the  professor  himself  strictly  adheres  to 
it.  His  library  is  entirely  free  from  this  danger- 
ous class  of  publications,  but  abounds  in  light 
literature  of  every  description.  During  the  past 
year  the  professor's  theory  was  put  to  a  practical 
test,  and  the  sequel  furnishes  a  lesson  which  we 
wish  to  impress  upon  the  recent  graduates,  upon 
the  general  practitioner,  and  finally,  upon  the 
teachers  in  our  medical  schools.  A  question 
arose  in  the  profession,  as  to  the  propriety  and 
possibility  of  a  given  operation  in  the  department 
of  practice  which  this  professor  has  taught  in  a 
manner  peculiarly  his  own  for  a  score  of  years. 
Now,  as  often  happens,  this  operation  had  been 


WHAT  SHALL  WE  READ  ?  65 

discussed  almost  entirely  in  the  medical  journals, 
and  many  of  the  well-recognized  authorities  had 
therein  declared  the  operation  practicable  and 
proper.  The  inquiry  was  made  of  this  devotee 
of  novels,  whether  the  operation  was  approved 
by  any  responsible  author ;  to  which  he  returned 
an  emphatic  No  !  The  correspondence  was  sub- 
sequently published,  and  the  profound  ignorance 
exhibited  of  the  well-known  improvements  in  the 
branch  which  he  was  teaching,  has  rendered  the 
position  of  the  professor  truly  unenviable.  It 
will  doubtless  seem  quite  superfluous  to  those 
who  habitually  read  our  best  medical  periodicals, 
to  urge  the  importance  of  this  class  of  publica- 
tions, and  their  claim  upon  the  profession.  But 
whoever  will  institute  a  careful  inquiry  as  to  the 
number  of  medical  men  who,  even  if  they  sub- 
scribe to,  and  pay  for  a  medical  periodical,  read 
it  with  care  and  attention,  will  be  astonished  at 
the  result.  He  will  find  that  few,  comparatively, 
really  profit  by  the  journals  which  they  may  hap- 
pen to  take,  and  the  proof  of  the  fact  will  be  seen 
in  the  practice  of  the  individual.  For  those  who 
read  with  interest  our  best  medical  journals  are 
invariably  found  to  be  the  most  successful  prac- 
titioners, and  vice  versa.  But  this  indifference  to 
medical  journals  is  not  confined  to  the  general 
practitioners  ;  the  person  alluded  to  in  the  open- 
ing paragraph  of  this  article,  is  the  type  of  a 
class  of  public  teachers,  who  move  in  an  atmos- 
phere never  tainted  by  such  publications.     They 


66  WHAT  SHALL  WE  BEAD  ? 

discard  all  new-fangled  notions,  as  they  style  the 
improvements  and  discoveries  first  laid  before 
the  profession  through  this  medium,  and  annually 
repeat  to  their  classes  the  old  and  often  obsolete 
theories  which  they  themselves  learned  when 
students.  These  teachers  are  by  no  means  ex- 
ceptional, even  in  our  most  flourishing  schools. 
We  have  listened  to  lectures  on  surgery,  medi- 
cine, and  obstetrics,  within  a  few  years,  not  a 
whit  in  advance  of  the  age  of  Hunter,  Cullen,  and 
Denman.  Is  it  not  time  that  this  class  of  pro- 
fessors were  supplanted  by  men  who  are  capable 
of  teaching  these  branches  in  the  light  of  modern 
science?  The  question  has  frequently  been 
asked :  at  what  age  does  a  medical  man  be- 
come unable  to  keep  pace  with  scientific  dis- 
coveries, and  at  what  age  are  professors  in  our 
medical  colleges  no  longer  competent  to  instruct 
classes  in  the  latest  improvements  in  the  medical 
sciences  ?  We  shall  give  to  both  queries  one  an- 
swer :  when  a  medical  man  reaches  an  age  where 
his  self-conceit  leads  him  to  believe  that  he  can 
learn  nothing  from  medical  journals,  he  is  no 
longer  able  to  keep  pace  with  the  progress  of  the 
medical  science,  nor  to  instruct  classes  in  its  latest 
improvements.  In  view  of  these  facts,  therefore, 
and  of  the  deliberate  advice  given  from  profes- 
sional chairs,  we  deem  it  our  duty  at  this  time  to 
enter  a  plea  in  behalf  of  medical  journals,  as  the 
proper  reading  of  recent  graduates,  of  estab- 
lished practitioners,  and  even  of  the  professors 


WHAT  SHALL  WE  READ  ?  67 

in  our  medical  colleges.  "What  is  the  proper 
office  of  a  medical  journal?  Undoubtedly  it  is  to 
be  the  medium  of  communication  between  the 
members  of  the  profession.  Such  a  medium  is 
now  recognized  as  essential  to  the  progress  of 
every  science  and  every  art.  It  stimulates  to 
active  effort,  not  only  in  research,  by  the  constant 
attrition  of  minds  engaged  in  a  common  pursuit, 
but  to  the  practical  application  of  principles  and 
newly  discovered  facts.  It  performs  in  this  re- 
spect, to  the  profession  at  large,  the  same  office 
that  a  local  organization  does  to  the  few,  being 
the  medium  of  mutual  improvement  and  en- 
couragement. The  advantages  of  a  medical 
journal  to  the  general  practitioner,  who  has  to 
grapple  with  the  stubborn  facts  of  every-day 
practice,  are  incalculable.  They  have  not  unfre- 
quently  contributed  to  his  immediate  success,  by 
giving  him  timely  information  of  new  and  im- 
portant discoveries.  Many  of  the  most  valuable 
methods  of  practice  introduced  to  the  knowledge 
of  the  profession  within  the  last  five,  and  in  some 
casss  even  ten  years,  have  not  found  a  place, 
as  yet,  in  practical  treatises,  but  must  be  studied 
in  the  original  journal  where  the  paper  first  ap- 
peared. It  is,  indeed,  a  common  remark  that  the 
physician  who  keeps  pace  with  the  improvements 
in  his  art,  must  be  a  careful  student  of  medical 
periodicals.  Again,  the  medical  journals  fulfill 
another,  and  not  less  important  mission.  They 
elevate  the  tone  of  professional  morality;  they 


08  WHAT  SHALL  WE  READ  ? 

cultivate  a  just  and  liberal  criticism  ;  and  finally, 
they  establish  a  higher  standard  of  attainments. 
In  this  view,  we  welcome  the  appearance  of  new 
and  well-conducted  periodicals  in  distant  local- 
ities, and  regard  them  not  only  as  evidences  of 
the  progress  of  legitimate  medicine,  but  as  safe- 
guards against  the  bickerings  of  individuals  and 
the  encroachments  of  quackery.  And  we  take 
this  occasion  to  urge  upon  physicians  living  in 
localities  where  such  publications  exist,  the  duty 
of  sustaining  them  liberally,  both  by  literary  and 
pecuniary  contributions.  Finally,  they  tend 
powerfully  to  unite  the  profession  in  a  common 
brotherhood  for  the  attainment  of  those  rights 
and  privileges,  whether  social  or  political,  which 
are  due  to  legitimate  medicine.  The  triumph  of 
the  British  medical  profession  in  obtaining  the 
enactment  of  laws  designed  to  establish  it  upon 
a  firm  legal  basis,  is  a  striking  proof  of  the  power 
of  medical  periodicals  to  concentrate  its  sym- 
pathies and  influences.  No  country  has  greater 
need  of  such  publications  than  ours,  and  in  no 
country  may  they  exert  a  more  salutary  influence. 
With  free  institutions  susceptible  of  infinite  modi- 
fication, the  medical  profession  forming  a  most 
respectable  element  in  every  community,  how- 
ever remote,  may  wield  a  power  of  unlimited  ex- 
tent. This  power  it  is  the  province  of  the 
medical  journals  of  this  country  to  organize  and 
concentrate,  and  thus  ennoble  the  profession, 
and  advance  the  best  interests  of  society. 


XIII. 
DUTIES    OF   CORONER 


XT  is  well  established,  that  promptness  and 
certainty  in  the  punishment  of  criminals  are 
the  most  powerful  safeguards  which  society  has 
against  the  reckless  commission  of  crime.  When 
retributive  justice  overtakes  the  murderer  while 
his  hands  still  reek  with  the  blood  of  his  victim, 
the  most  salutary  check  is  given  to  homicide. 
In  the  early  history  of  all  communities,  we  find 
abundant  examples  of  the  sudden  and  permanent 
arrest  of  high  crimes  by  the  summary  punish- 
ment which  an  excited  populace  has  promptly 
inflicted  upon  the  offenders.  In  older  commu- 
nities, where  criminal  jurisprudence  is  so  admin- 
istered as  to  be  tardy  in  the  arrest  of  criminals, 
doubtful  in  their  conviction,  and  slow  to  inflict 
penalties,  we  see  crimes  of  every  grade  gradually 
multiply.  It  follows,  therefore,  that  that  com- 
munity is  best  protected  against  the  commission 
of  crime  which  has  the  most  effective  regulations 
for  the  apprehension  and  conviction  of  criminals. 
But  it  will  be  apparent,  that  efficiency  in  the  ex- 
ecution of  any  code  of  laws  presupposes  activity, 
vigilance,  and  intelligence  on  the  part  of  those 
whose  duty  it  is  to  enforce  it ;  without  these, 


70  DUTIES   OF   CORONER. 

laws  had  better  never  have  been  enacted,  for  they 
serve  rather  to  embolden  than  check  and  deter 
the  vicious.  One  of  the  most  important  officers 
in  the  execution  of  our  criminal  laws  is  the 
coroner ;  and  it  is  to  the  duties  of  his  office,  and 
the  manner  in  which  they  are  now  too  often  per- 
formed, that  we  wish  to  direct  attention.  Eng- 
lish jurisprudence  has  bequeathed  to  us  not  only 
the  form,  but  the  spirit  of  the  office  of  coroner. 
Originally,  it  wTas  connected  with  the  Pleas  of  the 
Crown,  and  was  of  the  most  honorable  character. 
The  Lord  Chief  Justice  of  England  was  the  prin- 
cipal coroner  in  the  kingdom,  and  could  exercise 
the  duties  in  any  part  of  the  realm.  The  coroner 
was  of  equal  authority  with  the  sheriff  in  keeping 
the  peace  ;  he  was  to  be  a  lawful  and  discreet 
knight ;  and  was  to  receive  no  fees  for  his  ser- 
vices. But  his  special  duties  were,  by  means  of 
a  jury,  to  make  inquiry  as  to  the  cause  of  death 
where  persons  die  suddenly,  or  are  slain,  or  die 
in  prison.  He  was  directed  to  inquire  "when 
the  person  was  slain  ;  whether  it  were  in  any 
house,  field,  bed,  town,  tavern,  or  company,  and 
who  were  there.  Likewise  it  is  to  be  inquired, 
who  were  culpable,  either  of  the  act  or  of  the 
force  ;  and  who  were  present,  either  men  or 
women,  of  what  age,  if  they  can  speak  or  have 
any  discretion.  And  such  as  are  found  culpable 
by  inquisition,  shall  be  taken  and  delivered  to  the 
sheriff,  and  committed  to  jail."  It  will  thus  be 
seen  that  the  original  duties  of  a  coroner  were 


DUTIES   OF  CORONEE.  ^     71 

most  important  in  the  prompt  detection  and 
arrest  of  criminals.  As  many  of  the  duties,  how- 
ever, pertaining  to  the  office  were  of  an  un- 
pleasant character,  such  as  examining  dead 
bodies,  gentlemen  of  rank  subsequently  shrank 
from  their  performance,  and  it  gradually  fell  into 
disfavor.  And  when,  at  length,  fees  were  added, 
it  became  the  prize  after  which  clamored  the 
lowest  grade  of  politicians.  Thus  has  fallen  into 
unmerited  disrepute,  an  office  once  honorably  dis- 
tinguished by  its  intimate  association  with  the 
highest  tribunals  of  justice.  But  notwithstand- 
ing this  degradation  of  its  character,  and  the  in- 
ferior grade  of  incumbents  consequent  thereon,  its 
functions  have  scarcely  been  changed.  In  most 
of  the  States  the  office  of  coroner  exists,  and  the 
rules  which  govern  it  do  not  differ  materially 
from  those  imposed  by  the  English  laws.  These 
are  loose  and  indefinite  to  a  degree  that  renders 
the  office  almost  nugatory  when  administered,  as 
it  now  too  often  is,  by  imcompetent  men.  The 
law  which  created  the  office  of  coroner  and  de- 
fined its  duties  centuries  ago,  still  governs  it  in 
spirit.  Notwithstanding  the  immense  increase 
of  those  subtile  agencies  by  which  crime  may  be 
clandestinely  perpetrated,  and  the  vast  improve- 
ment of  the  methods  of  investigating  the  causes 
of  death,  as  by  the  microscope,  by  chemical  ma- 
nipulation, and  by  accurate  pathology,  a  coroner 
is  still  allowed  to  make  as  superficial  an  exami- 
nation as  he  pleases,  and  render  a  verdict  as  to 


72  DUTIES   OF   CORONER. 

the  cause  of  death  in  terms  so  indefinite,  that  it 
can  not  be  classified  according  to  any  modern 
system  of  nomenclature.  Mr.  Farr  says  (Begis- 
trar  General's  Keport) :  "  The  causes  of  deaths, 
registered  as  the  result  of  a  solemn,  judicial  in- 
vestigation, are  the  most  unintelligible  in  the 
Register,  as  it  is  impossible  to  attach  a  specific 
idea  to  '  natural  death,'  to  '  visitation  of  God,' 
and  several  other  phrases  in  use  in  coroners' 
courts."  We  can  not,  indeed,  present  a  better 
illustration  of  the  utter  perversion  of  the  true  ob- 
jects of  this  office  than  that  drawn  from  actual 
experience.  An  arrogant,  conceited  official,  igno- 
rant not  only  of  the  first  principles  of  law  and 
medicine,  but  even  of  the  English  language,  de- 
cides as  to  the  cause  of  death  where  a  capable 
medical  attendant  is  in  doubt.  He  refuses  a 
post-mortem  examination,  probably  considering 
it  a  reflection  upon  his  intuitive  knowledge  of 
the  cause  of  death,  and  instructs  the  jury,  com- 
posed of  some  luckless  employees  lounging  in 
the  vicinity,  as  to  the  verdict  that  they  must  ren- 
der. This  must  not  be  taken  as  an  exceptional 
case ;  scenes  like  these  are  of  every-day  occur- 
rence in  our  city.  No  one  need  be  surprised 
that  New  York  has  gained  an  unenviable  noto- 
riety for  its  weekly  deaths  by  violence,  when  the 
officer  whose  duty  it  is  to  take  the  initiatory  step 
toward  the  arrest  of  criminals,  exhibits  such  gross 
ignorance  and  imbecility.  How  shall  these  evils 
be    remedied?     Two   methods    are    suggested. 


DUTIES   OF   CORONER.  _    73 

The  first  is,  the  abolition  of  the  office,  and  the 
transfer  of  its  duties  to  the  magistrates'  court, 
where  these  investigations  would  be  conducted 
in  a  legal  and  orderly  manner.  It  is  contended 
by  eminent  medical  and  legal  gentlemen  that  the 
interests  of  society  would  be  equally  subserved 
if  this  change  were  made.  Many  who  have  been 
obliged  to  attend  much  upon  a  coroner's  court, 
and  submit  to  the  insufferable  medical  and  legal 
pedantry  of  the  presiding  genius,  will  be  inclined 
to  favor  this  method  of  reform.  The  second 
proposition,  and  which  is  the  most  rational,  is  to 
remodel  our  laws  relating  to  the  office  of  coroner, 
and  compel  the  selection  of  a  competent  person 
as  its  incumbent.  The  laws  should  define  with 
exactness  the  various  duties  to  be  performed  by 
the  coroner,  such  as  causing,  in  all  cases,  post- 
mortem examinations  by  competent  persons,  such 
investigations  by  experts  as  the  present  state  of 
the  medical  sciences  requires,  to  determine  satis- 
factorily the  causes  of  death.  But  even  this 
would  fail  of  securing  an  enlightened  and  efficient 
medical  jurisprudence  without  qualified  coroners. 
That  this  officer  should,  in  general,  be  a  medical 
man  of  education  and  experience,  no  one  can 
doubt.  It  is  true  that  not  every  physician  is 
qualified  for  the  office  of  coroner,  but  we  hold 
that  a  medical  education  is  a  prerequisite  which 
the  law  should  establish. 


XIV. 
THE    SABBATH    QUESTION. 


EUROPEAN  travelers  in  this  country  are 
accustomed  to  remark  the  general  observ- 
ance of  the  Sabbath  as  a  day  of  rest  by  the 
masses  of  the  American  people.  So  strikingly 
does  this  custom  contrast  with  the  prevailing 
habits  of  continental  communities,  that  many 
have  regarded  it  as  a  distinctive  feature  of  our 
civilization.  Of  the  truth  of  this  observation 
there  is  no  doubt.  Although  as  a  people  we 
present  a  singular  admixture  of  the  European 
nations,  every  one  being  represented  but  in  va- 
riable proportions,  the  social  fabric  of  our  civili- 
zation was  firmly  laid  by  a  single  and  united 
class,  exiled  from  these  old  communities.  Dur- 
ing the  long  interval  of  nearly  two  centuries 
which  elapsed  between  the  first  settlement  of  the 
Protestant  refugees  in  America,  and  the  general 
emigration  of  all  classes  from  the  Old  World,  the 
principles  upon  which  our  civil  as  well  as  social 
institutions  were  established,  became  of  vital 
importance  in  the  opinions  of  the  people  to 
their  very  existence.  To  our  Puritan  forefathers 
are  we  indebted  for  many  of  our  distinctive  so- 
cial peculiarities,  and  for  none  more  directly  than 


THE   SABBATH    QUESTION.  -    75 

the  civil  as  well  as  Christian  Sabbath.  The  re- 
ligious observance  of  this  day  by  the  entire  com- 
munity was  regarded  of  such  consequence  to  the 
welfare,  not  only  of  the  individual,  but  of  the 
State,  that  government  early  took  cognizance  of 
it,  and  forbade,  under  severe  penalties,  the  slight- 
est infringement  of  its  sacred  obligations.  Lu- 
dicrous as  appear  many  of  the  civil  restrictions 
thus  imposed  upon  individuals,  we  can  not  fail 
to  recognize  the  deep  and  lasting  impression 
which  religious  training,  enforced  and  made  obli- 
gatory by  the  sanction  of  the  State,  has  made 
upon  our  social  and  civil  condition.  The  ob-. 
servance  of  the  Christian  Sabbath,  as  a  day  of 
rest  from  all  secular  employments,  and  for  the 
inculcation  of  religious  truths,  may  be  considered 
a  fixed  American  custom.  The  general  emigra- 
tion which  took  place  from  all  European  coun- 
tries during  the  last  quarter  of  a  century,  and 
converged  to  our  shores,  has  concentrated,  espe- 
cially in  large  towns,  a  people  educated  to  regard 
the  Sabbath  as  at  best  a  day  to  be  devoted  to 
recreation  and  amusement.  They  are  intolerant 
of  the  restraint  which  government  has  imposed, 
and  demand  entire  freedom  in  the  pursuit  of  self- 
gratification.  Within  the  last  two  or  three  years 
the  respective  advocates  of  these  two  phases  of 
social  and  civil  custom  have  been  arrayed  against 
each  other,  but,  as  yet,  the  American  idea  of  the 
Sabbath  has  prevailed  in  all  the  States  where 
the  question  has  been  agitated,  and  laws  have 
been  enacted  providing  still  stronger  safeguards 


76  THE   SABBATH   QUESTION. 

against  Sabbath  desecration.  While  it  is  true 
that  the  rigid  practice  of  all  the  virtues  in  the 
Decalogue  will  not  exempt  one  from  disease 
in  any  form,  it  is  equally  true  that  the  strictly 
virtuous  are  not  liable  to  a  long  catalogue  of 
maladies  which  by  preference  attack  the  vicious. 
No  one,  we  are  persuaded,  will  deny  that  the 
laboring  man  who  spends  his  Sabbath  with 
scrupulous  regard  to  its  religious  obligations,  is 
less  liable  to  those  common  vices  which  are  the 
exciting  causes  of  disease,  than  his  neighbor  who 
resorts  to  places  of  amusement.  Holidays  in 
general  are  acknowledged  to  be  universally  pro- 
ductive of  vice  and  crime  among  the  laboring 
classes.  The  source  of  the  evil  is  not  in  relaxa- 
tion from  labor,  but  in  the  pursuit  of  those  amuse- 
ments which  stimulate  the  passions,  and  in  the 
indulgence  in  intoxicating  beverages — the  uni- 
versal stimulus  to  vice.  If  these  latter  agencies 
were  entirely  withheld  during  holidays  and  Sun- 
days, all  observation  shows  that  the  amount  of 
vice  would  be  greatly  diminished.  We  may  cite 
facts  from  our  police  records  which  prove  this 
point  incontestably.  From  July  1857  to  Decem- 
ber 1858  (seventy-six  weeks)  there  was  no  re- 
straint in  this  city  upon  the  sale  of  liquors  on  the 
Sabbath,  and  the  following  is  the  comparison  of 
arrests  on  Sundays  and  Tuesdays  : 

Intoxication. 

Sundays 2,453 

Tuesdays 1,928 


liaorderly. 

Miscellaneous. 

Total. 

2,580 

4,080 

9,713 

1,865 

4,008 

7,801 

Excess  on  Sundays,      525  715  012         1,852 


THE   SABBATH   QUESTION.  .      77 

During  the  five  months  from  July  3  to  Decem- 
ber 1,  1859,  the  liquor  stores  were  closed  on  the 
Sabbath,  and  the  following  are  the  criminal 
statistics  of  the  two  last  days  : 

Intoxica-       Disor-         Assault  and        All  Total 

tion.  derly.  Battery.        others.       Arrests, 

Tuesdays 2,161       897  616        1,311      4,976 

Sundays 1,515       652  352  828       3,357 

Excess  on 

Tuesdays 646       245  264  483       1,619 

Thus  it  appears  that  when  the  liquor  stores 
were  open,  there  were  twenty- five  per  cent,  more 
arrests  on  Sundays  than  on  Tuesdays  ;  but  when 
they  were  closed,  the  arrests  were  nearly  fifty 
per  cent,  more  on  Tuesdays  than  on  Sundays. 
Another  fact  of  even  greater  importance  was  no- 
ticeable when  the  Sunday  liquor  traffic  was  sup- 
pressed, viz.,  a  steady  diminution  in  the  ratio  of 
arrests  on  both  Sundays  and  Tuesdays  is  re- 
corded. What  the  effect  of  this  universal  drunk- 
enness every  seventh  day  must  be  upon  the  health 
of  the  laboring  classes,  no  one  will  be  at  a  loss  to 
determine.  Medical  men,  however,  who  are  fa- 
miliar with  the  habits  of  the  poor,  are  cognizant 
of  the  fact  that  there  is  a  large  increase  of  sick- 
ness on  Monday,  the  results  of  the  previous  day's 
dissipation.  During  the  prevalence  of  epidemic 
diseases,  the  results  of  Sabbath  dissipation  are 
sometimes  frightful.  Cholera  numbers  its  vic- 
tims on  Monday  in  a  tenfold  greater  ratio  than 
on  any  other  day.     The  laboring  man  of  gener- 


78  THE   SABBATH   QUESTION. 

ally  good  health  is  thus  often  unable  to  resume 
his  employment  for  several  clays,  even  if  he  be 
not  discharged  by  his  employer  on  account  of 
his  delinquencies.  The  miseries  which  are  heaped 
upon  a  poor  family  by  a  Sunday  debauch  of  the 
husband  and  father  are  thus  often  incalculable. 
The  proposition  that  the  suppression  of  Sunday 
amusements,  as  theatrical  performances,  con- 
certs, etc.,  is  a  measure  tending  to  promote  pub- 
lic health,  will  not  be  readily  admitted  as  a 
necessity.  There  are  many  philanthropists  who 
compassionate  the  laboring  man  in  his  incessant 
toil  during  the  week,  and  desire  to  render  the 
Sabbath  not  only  a  day  of  rest  to  him,  but  of  rec- 
reation and  diversion.  It  is  true  that  a  Sabbath 
spent  in  rural  scenery,  away  from  the  excitements 
of  the  jostling,  city  crowd,  may  be  elevating,  re- 
fining, and  hallowing;  but  very  different  is  the 
effect  upon  the  morale  of  the  individual,  when  the 
day  is  occupied  with  boisterous  and  exciting  city 
amusements.  These  scenes  are  not  conducive  to 
rest,  or  even  recreation,  but  they  stimulate  the 
passions  and  appetites,  and  lead  to  the  wanton 
commission  of  offences.  Sunday  theatres,  sacred 
concerts,  etc.,  are  the  very  hotbeds  of  vice  in 
every  city  where  they  exist.  Prostitution  in  its 
most  attractive  form  and  exterior  allurement 
here  invites  the  unwary  and  unsuspecting.  One 
who  visited  these  resorts  on  Sunday  in  a  neigh- 
boring city,  says  that  in  some  he  found  the 
attendance  of  courtesans  serving  out  lager  beer 


THE   SABBATH   QUESTION.  79 

to  customers,  and  at  the  same  time  making  their 
assignations  with  such  as  may  be  inclined  thereto. 
The  class  of  persons  in  attendance  is  thus  given 
by  another  :  "  A  large  proportion  of  their  guests 
are  youth  of  both  sexes ;  but  there  have  been 
seen  in  many  of  them  children  of  tender  years, 
drinking  their  lager  and  sharing  in  their  sports. 
Probably  it  would  be  no  exaggeration  to  estimate 
the  number  of  people  gathered  in  these  places  on 
a  single  Sunday  night  at  fifteen  thousand ;  and 
the  whole  number  of  different  persons  patroniz- 
ing them  during  some  part  of  the  Sabbath,  at 
thirty  thousand."  In  view  of  the  facts  here 
briefly  presented,  it  requires  no  argument  to 
prove  that  liquor-selling  and  specious  amuse- 
ments on  the  Sabbath,  tend  not  less  to  degrade 
public  morals  than  to  deteriorate  public  health. 
The  necessity  of  reform  had  long  been  felt  by 
many  of  our  citizens.  Grand-juries  had  also  re- 
peatedly directed  attention  to  these  fruitful 
sources  of  crime  and  disease,  and  called  for  the 
enforcement  of  the  laws  designed  for  their  sup- 
pression. Stimulated  by  these  appeals,  and  the 
request  of  citizens,  the  police  commissioners  at 
one  time  began  the  work  in  earnest,  and  both 
liquor-selling  and  theatres  on  the  Sabbath  were 
suppressed  in  this  city.  The  result,  as  shown 
above,  was  most  salutary ;  the  Sabbath  was  a 
day  of  the  most  perfect  quiet ;  good  order  pre- 
vailed everywhere ;  and  Monday  was  no  longer  the 
day  of  the  largest  percentage  of  sickness.     It  is 


80  THE   SABBATH   QUESTION. 

surprising   that   any   one   could  be   found  ■who 
should  petition  our  Legislature  "  to  repeal  an  act 
to  preserve  the  public  peace  and  order  on  the 
first  day  of  the  week  ;"  and  it  is  truly  astonishing 
that  such  petition  should  find  a  legislative  com- 
mittee willing  to  report  favorably  upon  it.     As 
medical  men,  we  protest  against  the  repeal  of  the 
laws  designed  to  promote  good  order  and  sobriety 
on  the  Sabbath.     Nearly  every  State  in  the  Union 
throws  around  this  day  legal  restrictions  which 
prevent  the  disturbance  of  its  hours  of  repose, 
and  encourage  the  contemplation  of  moral  sub- 
jects.    The  Legislature  of  this  State  should  heed 
the  eloquent  appeal  of  the  minority  report,  which 
certainly  meets  the  hearty  approbation  of  every 
well-disposed  citizen :  "  In  view  of  the  fact  that 
the  repeal  of  any  portion  of  the  laws  in  question 
would  involve  a   departure  from  the  legislative 
policy  of  this  Commonwealth  for  more  than  two 
centuries ;  that  it  would  contravene  the  known 
convictions  of  the  great  body  of  good  citizens  in 
all  parts  of  the  State,  as  it  would  be  abhorrent 
to  the  moral  sense  of  the  entire  Christian  com- 
munity ;  that  it  would  encourage  a  spirit  of  law- 
lessness, immorality,   and  vice;   that  i£  would 
remove  the  barriers  protecting  the  laboring  poor 
from   their  tempters   to  drunkenness   and  folly 
— we  submit  that  the  bill  reported  by  the  ma- 
jority of  the  committee  ought  not  to  pass." 


XV. 
THE    ILLEGITIMATE. 


IN  considering  the  subject  of  wet-nursing,  we 
assumed  that  the  practice  is  a  great  evil, 
and  endeavored  to  point  out  the  responsibilities 
of  our  profession  for  its  continuance,  and  the 
duties  of  individual  physicians  with  reference  to 
the   nurse  and  her  own  child.     The  latter,  we 
stated,  is  too  often  set  aside  to  make  room  for 
the  new  and  more  consequential  nursling,  help- 
less and  uncared  for,  except  by  the  unfortunate 
mother.     The  thoughtful  and  humane  physician 
(these  qualifying  terms  are  important)  will  recog- 
nize here  a  duty  to  perform  which  it  would  be 
criminal  to  neglect.     He  will  see  to  it  that  the  in- 
fant of  the  nurse  is  properly  provided  for,  that  it 
may  suffer  as  little  detriment  as  possible  by  the 
necessary  but  deplorable  deprivation  of  its  natural 
source  of  nutriment,  as  well  as  of  maternal  care 
and  sympathy.     This  responsibility  has  hitherto 
been    generally  overlooked,   but   we    trust   will 
hereafter  be  regarded.     We    shall,   indeed,   be 
abundantly  rewarded,  if  we  have  succeeded  in 
drawing  the  attention  of  a  single  practitioner  to 
this  subject,  so  as  to  impress  him  with  the  im- 
portance of  his  individual  efforts,  first,  in  counter- 
4* 


82  THE   ILLEGITIMATE. 

acting  the  fatal  heresy,  that  a  mother  may  nurse 
her  own  offspring  or  not  as  she  "  takes  a  fancy," 
and,  second,  when  necessity  leaves  no  choice  but 
the  selection  of  a  wet-nurse,  that  he  must  as  ten- 
derly provide  for  the  helpless  child  of  the  nurse, 
as  for  the   little   patient   under   his   immediate 
charge.     Akin  to  the  subject  of  wet-nursing,  and 
the  professional  duties  and  moral  obligations  of 
physicians  which  grow  out  of  it,  is  the  manage- 
ment of  illegitimate  children.     That  illegitimacy 
is  an  unmitigated  evil,  no  rational  person  can 
deny.     The  very  definition  of  the  term  implies 
the  moral  destruction  of  one  human  being,  and 
the  physical  deterioration  or  death  of  another. 
The  history  of  the  miserable  victim  of  seduction 
may   too   often   be   comprised  in   three  words  : 
disappointment,  abandonment,  prostitution ;   while 
the  history  of  her  offspring  may  be  still  more 
concisely  written :    neglect,  death.     It  is   a  well- 
established  fact  that  this  evil  widely  prevails  in 
this  country,  and  to  a  deplorable  extent  in  our 
large   towns.     This  may   be   inferred   from   the 
gradual  annual  increase  of  still-births  and  abor- 
tions, and  the  increasing  frequency  of  applica- 
tions of  unmarried  women  for  admission  to  our 
lying-in  institutions.     While  it  is  true  that  abor- 
tions and  still-births  are  by  no  means  generally 
the  result  of  an  effort  to  escape  this  disgrace,  it 
can  not  be  denied  that  such  is  very  often  the  case. 
The  experience  of  medical  men  tends  to  prove 
that,  in  the  majority  of  instances,  this  cause  un- 


THE   ILLEGITIMATE.  83 

derlies  the  greater  number  of  applications  to  have 
abortion  produced.  Dr.  Sanger,  who  carefully 
investigated  the  social  condition  of  the  prosti- 
tutes of  New  York,  says  :  "  To  speak  in  plain 
terms,  of  every  hundred  children  borne  by  women 
who  are  now  prostitutes,  forty-three  were  born 
before  the  mothers  (married  women  or  widows) 
embraced  this  course  of  life."  Whatever  the  ex- 
act truth  may  be,  it  is  safe  to  assume,  as  above, 
that  illegitimacy  is  a  great  and  growing  social 
evil  in  this  country.  "We  do  not  propose  to  dis- 
cuss at  length  the  various  questions  which  sug- 
gest themselves  as  we  review  this  subject,  but 
simply  to  consider  the  following  proposition : 
What  are  the  claims  of  the  illegitimate  ?  If  this 
question  were  to  receive  a  judicial  decision,  we 
are  aware  that  this  unfortunate  class  would  have 
their  civil  privileges  abridged  ;  society,  and  even 
the  medical  profession,  seem  to  regard  them  in 
very  nearly  the  same  light.  When  the  victim  of 
seduction  first  realizes  her  shame  and  approach- 
ing downfall,  she  readily  finds  kind  friends,  and 
occasionally  a  very  benevolent  physician,  who 
are  only  too  anxious  to  aid  her  in  destroying  the 
testimony  of  her  dishonor.  They  place  the  rep- 
utation of  one  human  being  in  contrast  with  the 
life  of  another,  and  find  no  difficulty  in  deciding 
that  the  latter  should  be  sacrificed  to  save  the 
former.  If,  however,  the  victim  of  this  conspiracy 
eludes  the  toils  of  the  abortionist  and  his  abettors, 
and  at  length  breathes  the  vital  air,  "  a  living 


84  THE   ILLEGITIMATE. 

soul,"  it  first  sees  the  light  in  some  secret  cham- 
ber, or  distant  asylum  ward,  as  if  to  be  born  in 
due  time,  according  to  the  laws  of  nature,  was  a 
shame  and  disgrace.  The  crime  against  the  ille- 
gitimate begins  even  before  its  birth,  and  is 
prosecuted  without  cessation  to  its  death.  Good, 
religious  people,  with  the  most  praiseworthy  in- 
tentions, are  anxious  to  save  the  mother  from 
ruin,  by  reinstating  her  in  her  former  social  po- 
sition. In  the  accomplishment  of  this  object,  one 
insuperable  obstacle  must  be  overcome.  This  is, 
such  a  complete  and  permanent  separation  of 
mother  and  child  as  will  amount  to  a  perfect  ob- 
literation of  all  natural  ties,  and  render  each  as 
independent  of  the  other  as  if  no  peculiar  relation 
ever  existed  between  them.  In  this  unhallowed 
work  the  physician  is  a  willing  accomplice.  He 
watches  with  painful  suspense  the  last  pangs  of 
parturition,  in  the  hope  that  he  can  announce  a 
still-birth  to  the  attendants,  and  should  the  torch 
of  life  flicker  in  the  first  breath  of  animation,  he 
makes  no  special  effort  to  protect  and  fan  its 
feeble  flame.  With  nimble  fingers  he  prepares 
it  for  its  swaddling  clothes,  and  so  quietly  and 
dexterously  passes  it  out  of  the  room,  that  its 
first  helpless  petition  for  maternal  care  and  pro- 
tection never  greets  a  listening  mother's  ear. 
The  kidnapping  is  complete  ;  the  little  outlaw  is 
conveyed  by  unknown  hands  to  unknown  parents, 
and  after  a  miserable  existence  of  a  few  weeks,  or 
months,  or  years,  disappears  forever,  to  the  great 


THE  ILLEGITIMATE.  85 

relief  of  the  anxious  participants  in  the  con- 
spiracy against  its  existence.  A  few  pious  ejacu- 
lations, as — "  Poor  fatherless  child  !  How  for- 
tunate that  it  has  died  young  !  What  a  life  of 
sorrow  it  has  escaped!"  and  the  history  of 
the  illegitimate  is  forgotten.  "We  have  recorded 
here  the  history  of  nine-tenths  of  the  pseudo- 
orphan  children  that  enter  our  alms-houses  and 
many  of  our  asylums.  Few  of  them  survive  the 
fifth  year  of  their  orphanage,  while  vast  numbers 
perish  within  the  first  twelvemonth.  Those  who 
chance  to  reach  adult  life  are  too  often  the  sub- 
jects of  inveterate  diseases,  and  their  manhood  is 
marked  by  the  decrepitude  and  dependence  of 
old  age.  The  question  which  we  wish  to  press 
upon  the  conscience  of  every  medical  man  is : 
Has  not  the  child  an  inalienable  right  to  its 
mother,  let  the  accidents  of  its  birth  be  what  they 
may?  Admitting  that  a  child  may  be  reared  by 
a  nurse,  and  that  between  them  the  physical  re- 
lations seem  properly  adapted,  still  who  can 
doubt  that  instinctive  sympathies  and  secret  in- 
fluences exist  between  parent  and  offspring, 
highly  essential  to  the  growth  and  symmetrical 
development  of  the  latter  ?  How  often  does  the 
nursling  languish  in  the  care  of  the  most  atten- 
tive nurse,  as  if  from  some  secret  grief  to  which 
it  can  give  no  utterance  ?  Let  him  who  wishes 
to  prove  this  truth  visit  the  alms-house,  where  he 
may  read  in  the  pinched  faces  of  five  hundred 
starving  infants,  as  on  so  many  printed  pages, 


86  THE   ILLEGITIMATE. 

the  sorrows,  diseases,  and  lingering  death  which 
surely  follow  maternal  desertion.  What,  then,  is 
our  plain  duty  as  medical  attendants  at  the  birth 
of  illegitimate  children,  or  as  advisers  of  parties 
who  are  interested  in  these  unfortunate  beings  ? 
— for  in  the  great  majority  of  cases  a  regular  phy- 
sician is  consulted  at  some  period.  We  should 
not  less  consider  the  welfare  of  the  child  than 
that  of  the  mother.  Though  it  may  be  for  her 
interest  and  happiness  to  be  restored  to  society, 
unsuspected  of  crime,  let  us  remember  that  it 
will  doubtless  be  effected  by  the  destruction  of 
the  child.  If  we  sunder  the  life-giving  ties  which 
bind  mother  and  child,  and  place  the  latter  where 
it  lingers  out  a  miserable  existence  of  a  few 
months  or  years,  are  we  guilty  of  a  less  crime 
than  the  mother  who  grasps  her  offspring  by  the 
throat  and  ends  its  life  with  its  birth?  No, 
verily.  Plainly  then,  our  duty  is  to  insist  that  the 
mother  is  responsible  for  the  care  and  support 
of  her  child,  let  the  social  consequences  to  her- 
self be  what  they  may.  To  abandon  her  offspring 
is  as  unjustifiable  as  infanticide,  and  he  who  ad- 
vises, aids,  or  abets  such  a  course,  is  particeps 
criminis. 


XVI. 
CONSEKVATIVE    SUEGEEY, 


SCIENTIFIC  surgery  proposes  as  the  prob- 
lem of  our  time :  How  may  diseased  or 
injured  limbs  or  parts  best  be  preserved  ?  The 
true  reputation  of  a  surgeon  is  now  based,  not 
on  the  number  of  limbs  amputated,  but  on  the 
number  saved  from  amputation — not  on  the 
amount  of  deformity  created,  but  on  that  relieved ; 
and  it  is  interesting  to  note  the  multifarious  ways 
in  which  this  problem  is  being  solved  by  earnest 
and  practical  students.  Shrewd  observers  of 
nature's  resources  are  devising,  and  cunning 
hands  are  executing,  in  every  department  of 
practical  surgery,  new  methods  of  removing  dis- 
eased parts  and  structures,  or  preserving  the 
healthy,  in  however  close  proximity.  So  well 
established  and  well  denned  are  many  of  the 
more  recent  rules  in  operative  surgery,  that 
operations  which  were  legitimate  a  score  of  years 
ago,  would  to-day  be  justly  accounted  malprac- 
tice. Let  us  notice  some  of  the  more  important 
advances  of  conservative  surgery.  The  regener- 
ation of  bone  from  the  preserved  periosteum 
enables  us  to  save  the  limb  in  necrosis.  The 
number  of  amputations  in  hospital  practice  was 


88  CONSERVATIVE    SURGERY. 

formerly  largely  increased  by  those  cases  of  ne- 
crosis which  involved  a  considerable  portion  of 
the  bone  of  any  extremity.     If  the  dead  bone 
was  removed  by  an  operation,  the   periosteum 
was  removed  also,  and  the  result  was  a  useless 
limb.     Surgeons  preferred,  therefore,  amputation, 
in  many  cases,  to  the  removal  of  the  dead  bone, 
so  much  would  the  limb  be  crippled  by  the  latter 
operation.     It  now  appears,  however,  that  the 
periosteum  has  the  power  of  reproducing  the  re- 
moved bone  entire,  and  in  a  condition  capable  of 
supplying  its  functions.     And  very  marvelous  are 
many  of   the  instances  of  the  reproduction  of 
bone.     We  may  have  the  entire  shaft  of  the  tibia 
renewed,  and  the  leg  restored  to  its  former  ser- 
viceableness.     The  radius,  with  its  complicated 
office  of  rotation,  is  equally  capable  of  regenera- 
tion, both  in  tissue  and  function.     The  clavicle 
has  thus  been  reproduced,  and  has  proved  quite 
as  useful  as  in  the  healthy  state.     The  most  re- 
markable instance  of  regeneration  is  seen  in  the 
inferior  maxilla,  which  has  now  been  so  frequently 
reproducedjentire,  with  the  exception  of  the  teeth, 
that  its  renewal,  when  the  periosteum  is  preserved, 
may  always  be  prognosticated.     The  rule  may 
be  considered  established  on  immutable  princi- 
ples, that  in  the  removal  of  bone,  we  may  have 
the  vacancy  supplied  with  the  same  tissue,  if  the 
periosteum  is   preserved.     Amputation   in  such 
cases,  though  formerly  sanctioned,  would,  in  our 
day,  be  an  unjustifiable  procedure,  if  performed 


CONSERVATIVE   SURGERY.  .  89 

simply  because  of  extensive  necrosis.     The  re- 
section of  diseased  and  injured  joints  enables  us 
to  save  many  limbs  which,  though  not  as  useful 
as  the  originals  were,  still  can  not  be  compensated 
by  any  artificial  contrivance.     All  the  joints  have 
been  subjected  to  this  operation,  and  with  re- 
sults such  as  render  it  highly  encouraging,  espe- 
cially in  the  upper   extremity,   if    not    always 
advisable,  when  the  question  lies  simply  between 
resection  and  amputation.     In  the  Crimean  war, 
the  mortality  of  these  operations  appears  strik- 
ingly favorable  to  resections ;  thus,  of  amputa- 
tions  at  the   shoulder-joint   one-third   died,    of 
resections  one-thirteenth  ;  of  amputations  of  the 
arm  one-fourth  died,  of  resections  of  the  elbow- 
joint  one-sixth.     Statistics  on  a  larger  scale  give 
for  excision  of  the  shoulder  a  mortality  22.5  per 
cent.,  and  amputation  at  the  same  joint  40.8  per 
cent. ;  excision  of  the  elbow-joint  a  mortality  of 
22.15,  and  amputation  through  the  arm  33.4  per 
cent. ;  showing  that,  as  a  question  of  safety,  ex- 
cision is  to  be  preferred,  at  these  joints,  to  ampu- 
tation,  when   there    is    opportunity   to   choose. 
Eesections  of  the  hip  and  knee  joints,  though 
perhaps   not   as  well   established  as  the   same 
operation  at  the  elbow  and  shoulder,  are  well-rec- 
ognized  surgical   expedients   for   saving   limbs. 
Resection  of  the  head  of  the  femur  for  morbus 
coxarius  has  given  excellent  results,  and  in  mili- 
tary surgery  is  far  more  successful  than  amputa- 
tion at  the  hip-joint.     Resection  of  the  knee-joint 


90  CONSERVATIVE   SURGERY. 

lias  saved  scores  of  useful  limbs,  which  the  older 
surgeons  would  have  condemned,  and  may  to-day 
be  set  down  in  the  catalogue  of  accepted  opera- 
tions in  conservative  surgery.  The  resection  of 
bones  is  a  method  of  avoiding  amputation  worthy 
of  the  attention  of  every  surgeon.  The  individ- 
ual bones  of  the  tarsus  or  carpus,  when  diseased, 
and  rendering  the  extremity  useless,  may  be  re- 
moved with  the  restoration  of  the  usefulness  of 
the  limb.  The  astragalus  may  be  removed  with  a 
percentage  of  about  86  cures,  and  the  calcaneum 
with  a  percentage  of  about  99  cures,  in  cases 
where  formerly  amputation  was  performed  with 
a  mortality  of  30  per  cent.  Gunshot  wounds  of 
the  articular  extremities  of  bones  are  now  not  to 
be  treated  by  immediate  amputation,  but  by  re- 
section. Esmarch  has  shown  that  resection  of 
the  head  of  the  os  brachii  should  be  preferred  to 
amputation  when  even  four  inches  of  the  bone 
are  involved,  the  resulting  limb  being  useful. 
The  free  opening  of  joints,  now  so  confidently 
asserted  by  some  to  be  harmless,  and  as  strenu- 
ously denied  by  others,  may  yet  relieve  us  from 
the  necessity  of  amputation  in  those  cases  in 
which  the  larger  joints  are  involved  in  injuries. 
In  military  surgery,  the  rule  of  treatment  in  gun- 
shot wounds  fracturing  the  articulating  ends  of 
the  bones  entering,  for  example,  into  the  knee- 
joint,  would  be  immediate  amputation  of  the  thigh. 
But  if  it  is  proved  that  the  joint  may  be  freely 
laid  open  in  such  cases,  the  fragments  removed, 


CONSERVATIVE   SURGERY.  91 

and  the  wound  treated  as  an  open  sore,  without 
endangering  the  life  of  the  patient  by  the  com- 
plication of  a  suppurating  joint,  a  great  point  is 
gained,  and  fewer  amputations  of  the  legs  will 
be  performed  hereafter,  both  in  civil  and  military 
practice.  "We  believe  the  day  is  not  distant  when 
this  will  be  the  established  practice  in  injuries, 
and  in  many  diseases  of  the  joints.  In  military 
surgery,  Stromeyer  has  already  put  it  to  the 
test  by  laying  the  front  of  the  knee-joint  freely 
open,  as  if  for  exsection,  in  a  case  of  gunshot 
wound,  with  encouraging  results.  The  frequent 
accidents  in  which  the  entire  joint  is  exposed, 
and  yet  complete  cures  are  effected,  with  no  un- 
favorable symptoms,  confirm  this  opinion.  The 
rule  to  save  as  much  of  the  limb  as  possible, 
when  amputation  is  inevitable,  is  a  prominent 
feature  of  the  surgery  of  our  day.  Its  advan- 
tages are  especially  seen  in  the  lower  extremity  in 
the  amputations  at  the  ankle-joint.  The  simple 
methods  of  Syme  and  Pirogoff,  by  which  the 
limb  is  rendered  nearly  as  serviceable  as  with 
the  foot  complete,  illustrate  well  the  advance  of 
our  art.  We  have  thus  pointed  out  some  of  the 
methods  by  which  conservative  surgery  is  accom- 
plishing its  beneficent  mission.  We  could  adduce 
examples  from  every  branch  of  practice,  but 
these  may  suffice. 


XVII. 
PUBLIC     BENEFACTORS. 


6  6  TTTTAPPY  the  man,"  says  an  old  moralist, 
|~|  "who  has  never  had  the  misfortune 
to  discover  or  invent  anything  useful  or  profit- 
able to  mankind."  At  the  first  blush  no  state- 
ment would  appear  more  paradoxical.  In  all  the 
wide  world,  that  man  esteems  himself  the  most 
fortunate  who  realizes  the  consummation  of 
years  of  dreaming  in  the  full  perfection  of  a 
curious  or  useful  invention.  Every  discovery  in 
the  arts  and  sciences  has  apparently  made  at 
least  one  man  happy.  From  Archimedes  to  the 
last  inventor  of  a  Yankee  notion,  the  ecstatic 
shout  of  every  discoverer  has  been,  Eureka ! 
Eureka  !  And  this  burst  of  enthusiasm  far  less 
often  gives  expression  to  the  unselfish  gratifica- 
tion of  genius  triumphing  over  the  "hidden 
things  in  nature,"  than  to  that  inordinate  and 
insatiable  desire  for  fame,  wealth,  and  ease,  al- 
ways existing  in  a  state  of  expectancy  in  the 
human  breast.  We  can  conceive  of  no  sublunary 
honors  or  rewards  more  likely  to  be  acceptable  to 
man,  than  to  be  known,  through  his  inventions  or 
discoveries,  as  a  public  benefactor.  But  he  alone 
is  the  correct  observer  of  the  sources  of  happi- 


PUBLIC   BENEFACTORS.  93 

ness  and  misery  among  men,  who  penetrates  be- 
yond the  seeming  and  apparent,  which  gloss  the 
present,  and  contemplates  the  ultimate  bearing 
and  effect  of  current  events  on  the  lives  of  in- 
dividuals. And  whoever  thus  pauses  to  reflect 
upon  the  subsequent  lives  of  those  who  esteem 
themselves  the  benefactors  of  their  race,  by  the 
utilization  of  a  discovery  or  invention,  will  be 
forced  to  acknowledge  that  the  proverb  of  the 
moralist  has  a  profound  significance.  We  know 
not  what  example  he  may  have  observed,  where 
a  life  of  toil  in  the  patient  search  after  truth,  it 
may  be  through  poverty,  disappointment,  and 
disgrace,  but  crowned  with  ultimate  success,  had 
been  rewarded  with  the  most  relentless  persecu- 
tion and  cruel  defamation.  He  may  have  seen  a 
student  of  science,  after  years  of  labor  and  sacri- 
fice, educe  a  principle  of  world-wide  application 
to  the  arts  of  living,  only  to  have  the  remainder 
of  his  life  rendered  miserably  unhappy  by  the 
assaults  of  slander  and  detraction.  How  rarely, 
indeed,  does  the  public  benefactor  wear  his 
wreath  unchallenged  by  the  tongue  of  slander ! 
The  history  of  many  branches  of  science  and  art 
is  but  a  continuous  record  of  the  struggles  of  dis- 
coverers to  establish  their  just  and  honest  claims 
to  consideration.  Nor  does  this  conflict  cease 
with  the  death  of  the  devotee  of  science,  but  the 
tooth  of  envy  and  detraction  ever  gnaw  at  what 
of  reputation  may  have  survived,  until  this  too  is 
consumed,  or  until  posterity  may  haply  embalm 


94  PUBLIC  BENEFACTORS. 

it  beyond  the  possibility  of  destruction.  While 
these  remarks  are  true  of  science  in  general,  they 
are  eminently  applicable  to  medicine.  The  no- 
blest, most  learned,  most  self-sacrificing,  most 
magnanimous  profession  has  been  but  a  bear- 
garden from  the  time  of  its  founder  to  the  pres- 
ent. As  a  body  it  is  united  in  fraternal  and 
indissoluble  bonds,  against  any  and  all  attempts 
to  harm  its  integrity  or  impair  its  strength,  while 
it  is  rent  by  intestine  feuds,  and  distracted  by 
personal  assaults.  Envy  and  jealousy  rule  the 
hour,  and  hunt  down  innocent  virtue  with  a  fe- 
rocity that  knows  no  control.  We  need  not  in- 
stance examples  ;  they  will  recur  to  every  one  in 
ample  numbers.  From  Hippocrates  to  Morton 
— from  the  first  invention  to  the  latest  modifica- 
tion of  splints  for  the  treatment  of  morbus  cox- 
arius,  there  is  an  unbroken  line  of  martyrs.  We 
claim  to  be  students  of  the  most  progressive  sci- 
ence in  the  entire  circle,  and  yet  the  path  of  medi- 
cal progress  is  marked  with  the  crosses  on  which 
were  crucified  those  who  have  ventured  to  take 
a  single  step  in  advance  of  their  fellows.  Who- 
ever dares  to  raise  his  head  above  the  common 
level  and  assert  a  new  principle,  becomes  at  once 
the  target  at  which  a  thousand  shafts  are  launch- 
ed, and  too  often  by  unseen  hands.  With  a  cer- 
tain class  of  medical  men,  we  know  of  no  greater 
stimulus  to  research  than  the  announcement  of  a 
new  invention  in  the  mechanics  of  our  art,  or  a 
new  principle  in  its  science.     Busy  hands  are  at 


PUBLIC   BENEFACTOKS.  95 

once  at  work  in  our  libraries,  musty  volumes  are 
rudely  taken  from  their  dusty  retreats,  medical 
journals  through  long  unindexed  series  are  con- 
sulted page  by  page,  modern  Latin,  old  French, 
obsolete  German  text,  are  deciphered,  and  in  due 
time  an  elaborate  article  appears,  proving  con- 
clusively that  this  contemporary  discovery  was 
well  known,  or  at  least  hinted  at,  in  some  former 
period.  We  are  amazed  at  the  revelation,  and 
marvel  that  so  little  should  be  known  of  it  in  our 
day.  In  our  surprise  we  forget  the  just  claims  to 
our  gratitude  of  him  who  has  reproduced  and 
utilized  a  principle,  dimly  perceived,  perhaps,  and 
but  obscurely  apprehended  by  his  predecessors. 
Reclamation  and  crimination  follow,  and  though 
our  knowledge  of  the  past  may  be  advanced,  it  is 
at  the  expense,  too  often,  of  the  just  reputation, 
may  be  life-long  discouragement,  of  a  worthy 
member  of  our  fraternity.  "We  have  long  since 
come  to  commiserate  in  advance  the  man  who  is 
about  to  make  public  something  new  in  his  pro- 
fession. Whatever  may  be  the  character  of  the 
discovery,  whether  a  new  elementary  body  in 
nature,  a  new  remedy,  a  new  physiological  or 
pathological  process,  or  a  new  surgical  instru- 
ment or  appliance,  we  can  assure  him  that  his 
claims  to  novelty  will  be  disputed.  We  may  re- 
fer to  hundreds  of  examples  within  our  recollec- 
tion where  the  medical  enthusiast,  after  long  and 
patient  effort,  has  committed  to  the  public  press 
his  claims  to  discovery,  only  to  meet  with  the  ten- 


96  PUBLIC   BENEFACTORS. 

der  epithet,  "plagiarist."  Who  doubts  that  Sims 
utilized  the  silver  suture  ?  and  yet  a  long  and 
elaborate  essay  has  been  written  by  an  Edin- 
burgh Professor  to  prove  that  metallic  ligatures 
were  previously  used  !  Thomas  has  demonstrated 
the  best  method  of  treating  a  prolapsed  funis, 
but  a  contemporary  writer  has  shown  that  a  Lon- 
don obstetrician  once  recommended  the  same 
practice.  Keid  has  taught  by  dissections  the 
most  obscure  practitioners  how  to  reduce  a  dislo- 
cated thigh,  but  a  learned  neighbor  has  dis- 
covered that  this  operation  has  been  accidentally 
performed  many  times  before.  Gait  invented  an 
ingenious  trephine,  but  the  moment  it  was  made 
known,  many  of  the  old  operating  cases  were  found 
to  contain  somewhat  similar  instruments.  Sayre 
illustrated  a  new  instrument  with  which  morbus 
coxarius  could  be  cured,  when  a  half  dozen  of  the 
same  sort,  long  since  invented,  were  brought  to 
light.  We  do  not  desire  to  deprecate  free  criti- 
cism on  the  utility,  and  even  originality,  of  in- 
ventions and  discoveries.  But  we  must  protest 
against  that  carping  and  cynical  spirit,  so  preva- 
lent in  the  profession,  which  always  strives  to  de- 
stroy, and,  failing,  to  lessen  the  merits  of  those 
who  really  advance  the  science  of  medicine.  The 
man  who  renders  useful  and  practical,  in  his  own 
age,  the  neglected  and  useless  ideas  of  a  past 
generation,  is  equally,  and  indeed  often  far  more, 
entitled  to  our  esteem  than  the  original  dis- 
coverer.    Whoever  is   imbued   with   the   liberal 


PUBLIC   BENEFACTORS.  97 

and  catholic  spirit  of  medicine  does  not  stop  to 
dispute  with  every  one  who  lends  him  aid.  Ac- 
cepting with  gratitude  every  means  by  which  his 
progress  can  be  advanced,  he  has  no  time  to  de- 
fame his  fellows,  and  no  disposition  to  question 
their  sincerity.  Were  this  the  spirit  that  ani- 
mated every  member  of  our  profession,  what 
causes  of  endless  wrangling  would  be  removed! 
What  sources  of  jealousy  and  heart-burnings 
would  be  forever  obliterated !  We  should  then 
present  to  the  world  the  pleasing  spectacle  of  a 
united  brotherhood,  governed  by  a  code  of 
morals  above  reproach.  Every  member  would 
fulfill  his  mission,  however  exalted  or  humble, 
and  receive  from  his  co-laborers  the  plaudit  of 
"  well  done."  The  inventor  would  rejoice  to  see 
his  theories  reduced  to  practice,  and  the  prac- 
titioner would  cheerfully  give  due  credit  and 
honor  to  one  who  had  rendered  his  labors  more 
simple  and  effective.  We  need  not  wait  for  the 
millennium  to  place  the  medical  profession  on 
such  a  peace  basis ;  let  each  physician  in  his 
position  cast  aside  forever  the  narrow  and  petty 
jealousies  which  govern  men  of  other  pursuits, 
and  the  reform  will  be  complete.  In  all  earnest- 
ness we  urge  the  cultivation  of  that  fraternal 
charity  which  suffereth  long  and  is  kind,  envieth 
not,  thinketh  no  evil,  and  rejoiceth  in  the  truth. 
5 


XVIII. 
PRELIMINARY    EDUCATION. 


THERE  is  no  literary  institution  in  the  United 
States  that  does  not  put  every  student  who 
seeks  to  enter  its  halls  to  the  test  of  a  rigid  ex- 
amination in  the  elementary  branches  of  learning. 
If  not  found  proficient,  or  not  to  have  attained 
the  required  standard,  he  is  refused  admission, 
and  compelled  to  turn  back  and  qualify  himself 
for  those  higher  studies,  or  seek  some  employ- 
ment better  suited  to  his  talents  and  acquire- 
ments.    We   are  not  aware   that   any  one   has 
complained  that  tins  system  is  too  rigid,  or  that 
it  is  unjust.     No  one  has  even  suggested  that  it 
were  better  to  allow  every  student  who  applies 
for  admission  to  the  classes  of  our  literary  insti- 
tutions to  go  through  a  regular  course  unchal- 
lenged   and   obtain    what   education   he   could, 
urging  that  thereby  he  would  be  a  more  useful 
man  than  he  possibly  could  be  educated.     The 
position  would  certainly  not  be  irrational,  and 
might  be  maintained  with  a  good  array  of  argu- 
ments.    On  the  contrary,   all  interested  in  the 
cause  of  education  unite  in  sustaining  the  system, 
and  give  the  best  support  to  the  colleges  whose 
examination  is  most  stringent.     Nor  do  the  pro- 


PRELIMINARY   EDUCATION.  ^         99 

fessors  in  these   institutions  complain   that   by 
being  thus  careful  in  guarding  the  portals  of  the 
halls  of  learning  they  so  effect  a  diminution  of 
their  classes  as  to  endanger  the  very  existence  of 
their  respective   schools.     There   exists   among 
them  a  spirit  of  emulation  which  exhibits  itself 
in  efforts  to  graduate  classes  well  appointed  by 
education  to  take  high  rank  in  subsequent  life, 
rather  than  in  measures  to  simply  swell  numbers 
regardless   of    their    educational   qualifications. 
The  true  measure  of  success  with  them  is  not  the 
quantity  but  the  quality  of  the  material  manu- 
factured.    Should  a  literary  institution  be  estab- 
lished which  admitted   all  who  chose  to  apply, 
without  an  inquiry  as  to  the  moral  character  or 
preliminary  education  of  the  applicant  until  the 
completion  of  the  prescribed  course,  we  can  have 
no  doubt  as  to  the  rank  which  it  would  take.     It 
might  boast  of  well-filled  halls,  of   overflowing 
classes,  of  a  long  catalogue  of  patrons,  but  it 
would  never  refer  to  the  educational  character  of 
its  graduates — the  real  test  of  its  merits.     Such 
a  literary  college  would  soon  become  a  hissing 
and  a  byword  among  the  educated,  and  would 
speedily  sink  under  the  load  of  infamy  which  it 
would  call  down  upon  its  devoted  head/by  such 
a  prostitution  of  its  powers.     It  would  be  repu- 
diated by   every  honorable,  conscientious,  and 
high-minded  student,  and  its  diploma  would  not 
be  worth  the  parchment  on  which  it  was  written. 
Its  testimonial  of  proficiency  in  learning  would  be 


100  PBELIMINARY  EDUCATION. 

but  a  price  set  upon  idleness,  incompetency,  and 
demerit.  While  our  literary  institutions  exhibit 
such  commendable  zeal  in  behalf  of  a  high  standard 
of  education,  and  consider  their  chief  excellence 
to  rest  in  the  character  and  not  the  number  of 
their  graduates,  our  institutions  for  medical  learn- 
ing pursue  a  diametrically  opposite  policy.  They 
esteem  the  true  measure  of  success  to  be  the 
number  of  their  graduates,  and  not  the  proficiency 
of  these  graduates  in  medical  science.  Their 
doors  are  not  only  thrown  widely  open  and  every 
one  invited  to  enter,  but,  in  some  cases,  their 
servants  have  been  sent  out  into  the  highways 
and  byways  to  compel  students  to  come  in  that 
their  lecture-rooms  might  be  full.  No  test  ques- 
tions must  be  put  to  such  guests,  lest  they 
should  take  it  as  an  insult  and  attend  a  neigh- 
boring school.  The  only  preliminary  examination 
ever  instituted,  that  we  are  aware  of,  was  as  to 
the  color  of  the  student.  Some  schools  have  not 
even  the  courage  to  exact  the  stipulated  fee  lest 
they  should  give  offence  and  diminish  their 
classes,  while  nearly  all  swell  their  lists  with  the 
names  of  many  who  are  not  full  students  of  med- 
icine. Under  the  title  "  beneficiaries "  many 
colleges  contrive  to  admit  large  classes  who  are 
totally  unfit  for  the  study,  and  much  less  the 
practice  of  medicine.  All  colleges  agree  in  waiv- 
ing an  examination  into  the  moral  character  and 
qualifications,  by  preliminary  education,  of  the 
student,  until  he  has  completed  the  course  of 


PRELIMINARY  EDUCATION.  101 

three  years  of  study,  and  an  attendance  upon 
two  full  courses  of  lectures.  And  what  if  he  is 
then  found  unqualified  ?  Ah !  but  who  ever  heard 
of  a  medical  student  after  "three  years'  study 
and  an  attendance  upon  two  full  courses  of  lec- 
tures, the  last  of  which  was  in  this  institution," 
who  was  not  found  qualified  ?  It  is  too  cruel 
after  three  years  of  study,  and  especially  after 
having  attended  the  last  full  course  of  lectures 
(and  paid  his  fees)  at  "this  institution,"  to  tell 
him  flatly  that  he  is  not  qualified  to  practice  med- 
icine. And  what  an  amount  of  assurance  on 
the  part  of  a  Faculty  would  it  not  require  to 
do  their  whole  duty  in  many  instances,  and  can- 
didly inform  the  candidate  that  he  had  altogether 
mistaken  his  calling  ;  that  he  was  never  qualified, 
either  by  natural  or  acquired  mental  force,  or  by 
early  education,  for  the  profession  of  mediciue  ; 
that,  in  a  word,  he  has  wasted  both  time  and 
money  in  his  present  pursuit,  and  must  now,  after 
fulfilling  all  the  required  terms  for  graduation, 
except  passing  a  "  satisfactory  examination,"  give 
up  the  course  of  life  which  he  and  his  friends 
had  marked  out  for  him,  and  seek  some  more 
congenial  avocation.  No  Medical  Faculty,  how- 
ever high-minded,  would  have  the  moral  courage 
to  take  from  a  student  his  time,  and  his  hard- 
earned  fees,  and  then  deliberately  tell  him  the 
truth  in  regard  to  his  qualifications.  Many  con- 
scientious professors,  anxious  to  do  their  duty  to 
the  profession,  and  yet  sympathizing  with  the 


102  PKELIMINAKY  EDUCATION. 

student,  whose  future  life  trembles  in  the  balance, 
are  annually  put  on  the  rack.  With  many  a 
doubt,  and  much  hesitation,  they  at  last  yield  to 
the  force  of  that  policy  which  makes  it  too  late 
to  deny  the  student,  when  he  is  first  put  to  the 
test  of  a  rigid  examination.  Thus  many  of  our 
best  schools  are  betrayed  into  granting  their  di- 
plomas to  graduates  who  not  only  disgrace  them, 
but  who  cling  like  a  nightmare  to  the  medical 
body  politic.  It  is  from  this  class  that  quack- 
ery, to  the  everlasting  shame  of  the  medical  edu- 
cating bodies,  gains  its  recruits.  Nor  can  we 
expect  better  things  until  a  radical  and  complete 
reform  is  made  in  our  system  of  medical  educa- 
tion ;  and  that  reform  is  suggested  by  the  prac- 
tice of  literary  institutions  of  examining  candi- 
dates on  their  first  application  for  admission  to 
the  course  of  instruction.  No  consideration 
other  than  the  desire  to  do  justice  primarily  to 
the  student,  and  secondarily  to  the  school,  could 
then  influence  the  judgment  of  the  examiner.  If 
the  applicant  were  disqualified  by  want  of  nat- 
ural abilities  to  acquire  a  proper  knowledge  of 
medicine,  he  would  be  unhesitatingly  informed, 
and  thus  doubtless  would  be  persuaded  to  aban- 
don a  pursuit  for  which  he  was  not  adapted.  If 
he  were  but  partially  qualified  by  preliminary 
education,  he  would  be  advised  to  establish  first 
the  basis  upon  which  he  was  to  build.  Thus  the 
profession  would  be  saved  the  infliction  of  mem- 
bership  of    the    incompetent    and    uneducated 


PRELIMINARY   EDUCATION.  103 

graduates  which  now  annually  swell  its  ranks. 
Although  the  institution  of  this  reform,  and  its 

O 

practical  fulfillment,  rests  with  the  medical 
schools,  yet  the  experience  of  the  past  has 
taught  us  that  the  impelling  power  is  with 
the  great  body  of  the  profession.  While  the 
false  idea  of  merit  obtains  among  colleges  that 
the  size,  and  not  the  educational  excellence, 
of  the  graduating  classes  is  to  be  regarded, 
no  reform  can  be  expected.  The  profession  at 
large  must  destroy  this  false  and  pernicious 
system,  create  a  new  standard,  and  bring  the 
schools  to  its  test.  It  may  appear  to  be  a  very 
difficult  undertaking  to  so  concentrate  the  influ- 
ence of  the  great  body  of  practitioners  as  to 
radically  change  old  and  hereditary  customs  in 
the  art  of  teaching,  especially  when  the  reform 
effects  the  pecuniary  interests  of  these  close  cor- 
porations ;  but  if  it  be  borne  in  mind  that 
schools  rely  upon  the  general  practitioner  for 
support,  and  that  they  not  only  desire,  but 
eagerly  seek  his  favor,  there  can  be  no  doubt  as 
to  the  power  of  the  latter  to  influence  the  for- 
mer. All  that  is  required  to  effect  this  object  is 
the  co-operation  of  the  various  medical  organiza- 
tions throughout  the  country  in  an  emphatic  in- 
dorsement of  a  given  plan,  and  the  schools  must 
conform  to  the  policy  indicated.  Nor  should 
such  action  be  longer  delayed. 


XIX. 
THE  AGE   OF  UTERINE  DISEASE. 


IT  lias  been  remarked  by  a  popular  writer  that 
this  is  "  the  age  of  uterine  disease."  In  the 
medical  profession,  and  with  the  other  sex,  the 
assertion  certainly  is  not  wide  of  the  truth. 
Uterine  diseases  have  been  the  all-engrossing 
theme  of  a  large  class  of  practitioners  for  many 
years.  Volumes  have  been  written  upon  these 
affections,  with  chaste  or  unchaste  illustrations 
of  every  grade,  from  the  secret  and  undetermined 
forms  of  sterility,  to  the  gravest  forms  of  cancer ; 
interminable  discussions  have  been  held  upon  the 
ever-varying  phases  of  the  diseases  of  this  organ  ; 
and  students  of  uterine  pathology  have  always 
been  rewarded  with  rich  discoveries  in  this 
fecund  placer.  If  we  were  to  believe  all  that  is 
written  of  the  inherent  and  acquired  diseases  of 
the  organ,  on  the  integrity  of  which  depends  the 
perpetuation  of  our  species,  how  surely  fated  to 
early  extinction  would  seem  the  human  race !  If 
it  be  perpetuated,  it  would  be  through  decaying 
germs  that  must  give  origin  to  imperfect  foims 
and  decrepid  generations.  But  while  it  is  true 
that  uterine  diseases  exist  and  form  a  large  class 
of  affections  which  are  capable  of  destroying  the 


THE  AGE  OF  UTEBINE  DISEASE.  105 

health  and  happiness  of  the  sex,  can  any  ob- 
servant practitioner  doubt  that  the  uterus  is,  in 
our  time,  the  scapegoat  of  many  a  latent  malady 
of  the  female   that   is   not   correctly  diagnosti- 
cated ?     Said  an  eminent  obstetrician  of  this  city : 
"If  I  should  confirm  the  diagnosis  in  every  case 
that  is  sent  to  me  from  the  country,  as  one  of  un- 
doubted uterine  disease,  I  could  add  thousands 
of  dollars  to  my  annual  income."     He  was  em- 
phatic in  the  expression  of  his  opinion,  that  medi- 
cal men,  nowadays,  conveniently  referred  to  the 
womb  a  vast  number  of  affections  of  which  they 
either  had  not  the  tact  or  knowledge  to  deter- 
mine the  seat    and   nature.     He  examined   the 
consulting  patient  with  an  habitual  anticipation 
of  finding  a  normal  condition.     Such  statements 
are  startling,  and  indicate  a  vast  amount  of  care- 
lessness or  ignorance,  or  both,  in  the  medical 
profession.     In   general,  no  diseases  are   more 
readily  susceptible  of   accurate  diagnosis  than 
those  peculiar  to  the  uterus.     They  belong,  in 
fact,  to  the  diseases  distinguished  by  the  French 
as  external  pathology.     If  there  is  an  ulcer  on 
the  parts,  it  is  seen  as  distinctly  as  if  on  the  leg ; 
if  there  is  unnatural  enlargement,  it  is  as  detecti- 
ble  as  a  swollen   finger ;   if  there  is  a  tumor  of 
any  kind  or  description,  it  is  as  demonstrable  as 
a  similar  growth  on  the  face  ;  if  there  is  displace- 
ment in  any  direction,  it  is  as  apparent  as  a  dis- 
located limb.     Indeed,  a  physician,  with  all  the 
mechanical  aids  which  we  now  possess  for  inves- 


106  THE   AGE   OF   UTERINE   DISEASE. 

tigating  uterine  diseases,  can  not  be  held  guiltless 
of  culpable  ignorance  who  pronounces  falsely 
upon  the  presence  of  grave  lesions.  He  has  no 
excuse  for  diagnosticating  an  ulcer  when  there  is 
none  ;  or  prolapsus,  when  the  organ  is  in  a  nor- 
mal position  ;  or  anteflexion  or  retroflexion,  when 
neither  exists.  And  yet  these  false  opinions  are, 
it  must  be  admitted,  daily  given,  greatly  to  the 
discredit  of  many  a  physician  in  the  eyes  of  an 
honest  and  competent  expert.  We  believe  that 
these  errors  are  generally  the  result  of  careless- 
ness. There  is  in  many,  also,  a  disposition  to 
give  always  a  definite  opinion,  especially  in  an 
obscure  case  ;  and  it  is  convenient  to  fix  upon  an 
organ  which  has  the  popular  acknowledgment  of 
being  the  happy  abode  of  all  the  undiscovered 
maladies  of  the  female  organization.  The  uterus 
has  now  come  to  enjoy  the  relative  position  of 
the  liver  in  its  ability  of  concentrating  within 
itself  all  the  undefinable  diseases  to  which  the 
sex  are  subject.  Although  the  term  "  liver  com- 
plaint" has  now  become  obsolete  in  the  nomen- 
clature of  many  practitioners,  yet  its  place  is 
more  than  supplied  by  the  phrase  "uterine  dis- 
ease." Aside  from  the  humiliation  of  profes- 
sional character  which  results  from  such  igno- 
rance and  carelessness,  there  are  other  evils  of  a 
very  different  kind  that  must  not  be  overlooked. 
We  have  thereby  opened  a  large  and  fertile  field 
for  the  special  advantage  of  quackery  in  its  low- 
est and  most  revolting  forms.     It  is  not  strange 


THE   AGE   OF  UTERINE   DISEASE.  107 

tliat  the  interesting  and  interested  subjects  of 
these  affections  have  become  alarmed  at  the 
almost  universal  prevalence  of  the  belief  in  the 
disabilities  peculiar  to  their  unfortunate  sex. 
Thousands  of  nervous  ladies  suffering  from  some 
slight  and  obscure  derangements  of  digestion,  or 
other  departure  from  health,  are  secretly  in- 
formed by  friends  that  the  womb,  that  mysterious 
organ,  with  its  innumerable  susceptibilities,  is 
liable  to  an  infinite  number  of  strange  disorders. 
At  once  a  mania  for  an  investigation  seizes  the 
individual  victim,  which  nothing  but  the  manipu- 
lations with  the  speculum  can  relieve.  And  alas  ! 
too  often  instead  of  relieving  a  proper  appre- 
hension on  the  part  of  the  patient,  even  though 
she  is  correctly  informed  that  the  womb  is  not 
diseased,  a  new  source  of  excitement  is  estab- 
lished which  is  far  more  dangerous  to  her  hap- 
piness than  actual  disease.  If  her  ailments  are 
lightly  treated  by  her  medical  attendant  she  read- 
ily falls  into  the  hands  of  a  vulgar  irregular,  and 
becomes  the  dupe  of  his  villanous  machinations. 
In  more  than  one  instance  has  the  profession  of 
this  city  witnessed  a  uterine  furor,  created  by  an 
unblushing  quack,  which  neither  reason  nor 
modesty  could  control.  And  but  recently  we 
noticed  an  instance  in  which  a  most  ignorant 
pretender  opened  a  hospital  for  the  treatment  of 
uterine  tumors,  in  one  of  the  most  intelligent  and 
moral  communities  of  an  interior  State  ;  crowds 
of  women  flocked  to  him,  and  all  were  found  to 


108  THE   AGE   OF  UTEKINE   DISEASE. 

be  suffering  from  tumors  of  the  womb.  By  acci- 
dent a  patient  more  intelligent  than  others,  dis- 
covered that  the  tumor  was  a  piece  of  raw  meat, 
which  was  introduced  at  the  first  examination, 
and  which,  after  long  treatment,  was  removed  to 
the  great  relief  of  the  patient.  It  is  time  that 
uterine  pathology  was  thoroughly  understood  by 
every  practitioner.  It  is  not,  as  we  have  already 
intimated,  difficult  to  learn  so  thoroughly  that 
mistakes  in  diagnosis  will  be  only  exceptions, 
and  not,  as  now,  the  rule.  And  physicians  should 
exercise  the  most  scrupulous  care  in  the  manage- 
ment of  such  diseases  where  they  really  exist, 
especially  in  the  unmarried.  He  has  then  not 
only  to  deal  with  a  local  disease  which  may  be 
readily  cured,  but  with  temperamental  conditions 
not  apparent,  yet  existing,  and  liable  to  be  de- 
veloped into  dangerous  activity.  The  term 
"  Speculum-mania,"  used  by  medical  practition- 
ers, may  yet  pass  into  the  nomenclature  of  the 
alienist.  It  is  certain  that  in  some  instances, 
and  they  may  be  far  more  numerous  than  we  sus- 
pect, the  local  treatment  has  been  regarded  as  the 
origin  of  a  moral  obliquity  which  terminated  in 
abandoned  lives,  and  occasionally  in  confirmed 
insanity.  In  no  branch  of  practice,  therefore, 
has  the  daily  practitioner  a  more  delicate  and 
responsible  duty  to  perform  than  in  the  treatment 
of  the  victims  of  uterine  disease. 


XX. 
HOSPITAL      CONSTRUCTION. 


HOSPITALS  are  great  public  necessities 
which  have  always  commanded  the  regard 
and  support  of  the  Christian  world.  No  appeal 
to  the  benevolent  is  more  likely  to  be  cheerfully 
responded  to  than  that  which  seeks  to  sustain 
these  institutions.  Governments  have  also  gen- 
erally recognized  their  value  ;  some  have  en- 
dowed them  liberally,  and  others  have  taken 
them  under  their  fostering  care,  and  lavished 
upon  them  untold  sums  of  money.  They  are,  in 
some  measure,  the  criteria  of  a  nation's  progress 
in  civilization,  and  the  measure  of  its  cultivation 
of  those  benevolences  which  spring  from  the 
heart  of  a  people  imbued  with  philanthropic 
sentiments.  And  yet  how  often  is  this  benevo- 
lent intention  frustrated  in  its  endeavors  to  bene- 
fit the  unfortunate  by  the  faulty  construction  of 
the  costly  structures  reared  for  their  benefit,  and 
consecrated  to  the  holy  purpose  of  relieving  hu- 
man suffering,  and  providing  a  home  for  the 
homeless  and  destitute  sick  !  Nay,  how  often  do 
these  very  buildings  become  the  sources  of  dis- 
ease and  the  causes  of  death  to  those  who  enter 
them  as  asylums  for  the  relief  of  their  individual 


110  HOSPITAL   CONSTRUCTION. 

maladies  !  Every  physician,  who  has  long  been 
attached  to  one  of  these  public  charities,  must 
have  felt  that  our  hospitals  are  too  often  the 
great  foci  of  endemic  diseases.  Typhus,  erysipe- 
las, scurvy,  hospital  gangrene,  and  all  those  affec- 
tions which  are  generated  and  always  intensified 
by  the  congregation  of  individuals,  here  prevail 
from  year  to  year,  with  no  other  alternation  than 
that  which  is  produced  by  the  change  of  seasons. 
Surgical  injuries  and  operations  here  reach  their 
maximum  of  mortality,  always  greatly  in  excess 
of  that  in  private  practice.  Lying-in  women  are 
decimated  with  a  pestilence,  so  palpably  the  re- 
sult of  local  causes,  that  it  seems  barbarous  to 
continue  these  departments  in  public  hospitals. 
Foundling  institutions  are  little  better  than  re- 
ceptacles where  these  unfortunates  are  prepared 
for  early  death,  or  imbecile  youth,  or  premature 
old  age.  In  military  practice  the  evils  of  the 
faulty  construction  of  hospitals  stand  out  so 
vividly  that  they  have  long  since  attracted  public 
attention.  The  remark  of  Sir  John  Pringle  that 
"hospitals  are  among  the  chief  causes  of  mor- 
tality in  armies,"  was  confirmed  in  the  Crimean 
war,  where  in  the  early  part  of  the  campaign 
nearly  one-half  of  those  treated  in  hospitals  died. 
Says  Rush,  an  active  and  intelligent  participant 
in  the  management  of  the  hospitals  in  the  war  of 
the  Revolution  :  "  Hospitals  are  the  sinks  of 
human  life  in  an  army.  They  robbed  the  United 
States  of  more  citizens  than  the  sword."     With 


HOSPITAL   CONSTRUCTION.  Ill 

rare  foresight  he  thus  intimates  the  reform  that 
would  remedy  this  evil :  "  Humanity,  economy, 
and  philosophy,  all  concur  in  giving  a  preference 
to  the  conveniences  and  wholesome  air  of  private 
houses  ;  and  should  war  continue  to  be  the  ab- 
surd and  unchristian  mode  of  deciding  national 
disputes,  it  is  to  be  hoped  that  the  progress  of 
science  will  so  far  mitigate  one  of  its  greatest 
calamities  as  to  produce  an  abolition  of  hospitals 
for  acute  diseases."  That  hospital  architecture 
has  made  great  advances  among  us  is  unde- 
niable ;  but  it  has,  as  yet,  failed  to  remedy  the 
evil.  Deficient  ventilation  has  been  justly  re- 
garded as  the  chief  cause  of  the  evils  of  our  hos- 
pital system,  and  multifarious  are  the  measures 
for  accomplishing  the  desired  improvement.  The 
natural  courses  of  cold  and  hot  air  have  been 
carefully  studied  ;  curious  ventilating  apparatus 
has  been"  constructed  to  conduct  the  air  along 
the  channels  which  it  seeks,  or  forcibly  compel  it 
through  devious  paths  from  which  it  recoils ; 
ceilings  have  been  elevated  and  wards  enlarged 
to  give  a  larger  atmospheric  area ;  but  still  we 
have  not  reached  that  degree  of  perfection  which 
is  attainable.  The  fundamental  error  in  our 
present  system  of  hospital  management  is  in  the 
aggregation  of  the  sick.  Whatever  may  be  the 
mode  of  ventilation,  however  cleanly  wards  may 
be  kept,  there  will  be  a  constant  and  over- 
powering generation  and  accumulation  of  the 
causes  of  those  diseases  dependent  upon  large 
collections  of  persons. 


XXI. 
OUR    STATUS   ABROAD. 


AN  American,  it  lias  often  been  remarked,  is 
decidedly  cosmopolitan  in  his  sympathies. 
He  refuses  all  restraints  in  his  intercourse  with 
the  world,  whether  in  trade,  in  science,  or  in 
literature.  This  feeling  not  only  leads  him  to 
seek  freely  for  whatever  may  interest  or  gratify 
him  wherever  it  may  be  found,  whether  at  home 
or  abroad,  but  it  tends  to  make  him  acknowledge 
unreservedly  the  source  from  which  it  is  ob- 
tained. To  what  these  national  peculiarities  are 
due  it  is  not  easy  to  decide,  though  we  may  sur- 
mise, that  as  the  American  people  is  a  melange 
of  all  the  nations  of  the  earth,  there  exists  among 
all  ranks  and  conditions  of  society  a  filial  affec- 
tion for  the  older  countries.  What  is  true  of  the 
American  people  in  this  general  sense,  is  also 
true  of  the  medical  profession.  We  are  accus- 
tomed to  seek  knowledge  in  every  quarter  of  the 
globe,  and  are  quite  as  much  rejoiced  to  learn 
the  discovery  of  a  new  principle  in  medical  sci- 
ence if  the  discoverer  be  an  Englishman,  French- 
man, or  German,  as  if  he  were  our  next-door 
neighbor  and  "  a  true  American."  It  is  alleged, 
indeed,  that  we  are  so  accustomed  to  look  to 


OUR  STATUS  ABROAD.  113 

other  countries  for  our  medical  knowledge,  that 
we  do  not  advance  medical  studies  at  home  ;  that 
we  have  no  national  medical  literature,  and  never 
can  have,  until  we  exchange  our  free-trade  policy 
for  protection.     However  that  may  be,  it  is  never- 
theless true,  that  the  general  and  rapid  diffusion 
of  information  in  the  profession,  gathered  from 
all  sources,  must  create  a  constantly  increasing 
demand  for  an  improved  medical  literature,  and 
gradually  elevate  the  tone  of  public  medical  sen- 
timent.    This  trait  in  our  character  has   been 
attributed  to  our  weakness,  to  our  want  of  re- 
sources, and  the  like ;  but  such  is  not  the  true 
explanation.     It  is  rather,  as  already  intimated, 
an  inherent  national  peculiarity,  growing  out  of 
the  make-up  of  our  people.     It  is  an  admirable 
trait  and  one  of  which  we  may  well  be  proud. 
While  Englishmen  discard   everything  French, 
and  the  French  everything  English,  and  the  Ger- 
mans reject  Anglo-French  ideas,  and  all  distiust 
the  "  Yankee  Nation,"  the  American  physician, 
as  a  member  of  the  Republic  of  Medicine,  ac- 
cepts, in  full  faith  and  confidence,  whatever  new 
and  useful  is  communicated  to  him  by  one  of  his 
fraternity.     While  we  pursue  this  liberal  policy 
out  of  the  most  generous  regard  for  the  rights  of 
others,  and  the  interests  of  medicine,  it  accords 
little  with  our  sense  of  justice  to  find  cases  pub- 
lished by  American  physicians,  styled  by  foreign 
journals    "American    Stories,"    and  repudiated 
simply  because  they  were  related  by  an  American. 


114  OUR   STATUS  ABROAD. 

It  can  not  be  denied  that  American  physicians 
have  reported  a  large  number  of  extraordinary 
cases  ;  but  many  of  them  have  been  remarkable 
only  because  they  were   the   first   of  the   kind 
placed  on  record.     We  may  instance  McDowell's 
case  of  ovariotomy ;  Mott's  cases  of  ligature  of  the 
arteria  innominata,  of  the  common  iliac,  and  of 
exsection  of  the  clavicle  ;  the  case  of  Alexis  St. 
Martin,  with  a  fistula  leading  into  the  stomach  ; 
and  finally,  the  case  of  Gage,  who  had  a  bar  of 
iron    driven    through    his  head    and  recovered. 
These  were  all  very  remarkable  cases,  and  were 
probably  at  first  pronounced  "  American  Stories ;" 
but  who  now  denies  the  accuracy  of  the  repoits? 
McDowell's  name,  with  universal  consent,  is  re- 
corded among  the   first   ovariotomists ;    Mott's 
patients   still  vindicate    the    correctness  of  the 
many  extraordinary  cases  which  he   published. 
Every  text-book  on  physiology  attests  the  import- 
ance of  the  investigations  into  digestion  conducted 
through  the  fistula  in  St.  Martin's  stomach ;  and 
finally,  the  patient  till  recently  survived  through 
whose  head  a  tamping-rod  (three  feet  seven  inches 
long)  was  projected  from  base  to  apex,  as  do  many 
reliable  witnesses  to  the  accident.     It  is  undoubt- 
edly true  that  cases  can  be  cited  where  American 
physicians  have  made  exaggerated  statements, 
but  it  is  altogether  unjust  to  infer  from  this  cir- 
cumstance that   the  profession  of  this   country 
is  thereby  rendered  obnoxious  to  the  charge  of 
publishing  "  exaggerated  facts  and  strained  con- 


OUR  STATUS  ABROAD.  115 

elusions."  We  believe  our  current  medical  lit- 
erature, so  far  as  relates  to  a  conscientious  re- 
gard to  accuracy  of  detail,  will  not  suffer  in 
comparison  with  that  of  any  European  country. 
Bub  aside  from  this  grievance,  the  American 
medical  profession  have  another  and  just  cause  of 
complaint  against  their  foreign  brethren.  Not 
only  do  the  latter  too  often  discredit  the  state- 
ments of  our  writers,  but  they  not  unfrequently 
seize  upon  important  discoveries  in  practical 
medicine,  first  made  among  us,  and  without  due 
acknowledgment  of  their  indebtedness,  intro- 
duce them  to  their  countrymen  as  their  own  in- 
ventions. We  could  mention  several  instances 
in  illustration,  but  the  following  example  will  suf- 
fice. The  method  of  reducing  dislocations  at  the 
hip-joint  by  manipulation  no  sane  medical  man 
who  has  any  knowledge  of  his  profession  will 
deny  was  introduced  into  practice  and  completely 
illustrated  by  Dr.  Eeid,  of  Eochester,  N.  Y. 
(U.  S.  A.)  This  method  of  reducing  dislocations 
was  never  alluded  to  by  any  foreign  journal  that 
we  receive,  until  the  full  details  were  republished 
in  one  of  the  English  semi-annuals.  Several 
.weeks  after  its  appearance,  a  London  journal  an- 
nounced that  a  surgeon  of  one  of  the  hospitals  of 
that  city  had  discovered  a  method  of  reducing 
dislocations  at  the  hip-joint  by  simple  manipula- 
tion, and  had  succeeded  perfectly  in  three  in- 
stances. The  details  of  the  method  were  given, 
and  they  were  precisely  those  published  by  Eeid. 


116  OUR   STATUS  ABROAD. 

No  allusion  whatever  was  made  to  Reid  by  way 
of  acknowledgment ;  the  surgeon's  name  was  im- 
mediately prefixed  to  the  method ;  reporters  and 
editors  extolled  the  ingenuity  of  the  operator ; 
and  to  this  time  it  is  familiarly  referred  to  as  this 
surgeon's  method  of  reducing  dislocations  of  the 
thigh.  We  are  quite  willing  to  admit  that  such 
instances  are  few  and  exceptional,  but  the  fact 
that  they  do  occur  in  the  very  centres  of  medical 
respectability  abroad,  certainly  tends  to  mitigate 
our  own  shortcomings,  and  to  relieve  us  some- 
what of  the  censure  which  we  so  frequently  re- 
ceive. We  deprecate  this  spirit,  and  regard  it 
as  inconsistent  with  the  liberal  and  fraternal 
feeling  which  should  pervade  all  ranks  of  a 
learned  profession.  Medicine,  cultivated  as  a 
science,  aims  by  innumerable  influences  to  unite 
its  members  in  a  universal  brotherhood,  and 
that  fraternity  should  be  one  of  perfect  equality. 
There  can  be  no  class  privilege,  no  aristocracy, 
and  no  distrust  among  medical  men  who  prop- 
erly estimate  the  honorable  character  of  their 
calling.  They  will  accord  to  each  new  member 
that  generous  confidence  and  fraternal  regard 
which  is  due  to  brethren  bound  together  by  a 
common  sympathy.  Nor  will  that  bond  be 
broken,  nor  that  confidence  destroyed,  except  by 
the  most  absolute  proof  of  professional  delin- 
quencies. 


XXII. 
CONCENTRATED   MEDICINES. 


ONE  of  the  most  wide-spread  of  the  popular 
errors  created  and  fostered  by  the  friends 
of  homoeopathy,  is  that  which  attributes  to  this 
pretentious  system  of  quackery  the  comparatively 
diminished  amount  of  medicine  prescribed  by 
regular  physicians.  And  it  far  too  frequently 
happens  that  medical  men  tacitly  or  openly  ac- 
knowledge the  truth  of  the  assertion.  Admitting 
the  fact  that  less  medicine  in  bulk  is  now  ad- 
ministered than  formerly,  they  see  no  other  ex- 
planation than  that  so  often  alleged  which  has 
now  well-nigh  passed  into  a  proverb.  The  ad- 
mission of  this  statement  is  utterly  false,  and 
damaging  to  the  profession.  Homoeopathy  is 
entitled  to  as  little  credit  for  the  improvement  of 
our  therapeutics  as  for  the  advancement  of  path- 
ological or  surgical  science.  It  is  important 
-  that  we  should  understand  on  what  basis  rests 
the  actual  changes  in  our  present  materia  niedica, 
that  we  may  give  a  rational  explanation,  and  not 
make  improper  concessions  to  quackery.  It 
should  be  understood  that  the  homoeopathic 
hypothesis  was  made  at  a  peculiar  period  in  the 
history  of  medicine,  and  one  well  adapted  to  give 


118  CONCENTRATED   MEDICINES. 

it  popularity.     About  the  time  of  its  promulga- 
tion a  great  change  had  taken  place  in  the  science 
of  chemistry,  especially  in  that  branch  which  we 
may  term  pharmaceutical  chemistry.     The  alka- 
loids, the  active  medicinal  principles  of  remedies, 
were  just  then  discovered,  and  by  this  discovery 
a  new  impetus  was  given  not  only  to  chemistry 
but  to  therapeutics.     The  oft  reiterated  query  of 
centuries — Can  you  not  give  your  remedies  in 
smaller  bulk,  and  in  a  more  agreeable  form  ? — 
was  about  to  be  answered.     It  was  apparent  that 
the  physician  could  give  the  same  strength  as 
formerly  in  a  very  much  less,  in  fact  in  a  minute 
dose,  and  there   was   hope   that   eventually  all 
medicines  would  be  thus  reduced.     Where  the 
older  practitioners  gave  opium  or  bark  in  large 
bulk,  the  younger  therapeutist  gave  the  small 
and  elegant  preparations  of  morphine  or  quinine. 
The  homoeopaths  very  early  finding  the  utter  in- 
ertness of  the  medicines  they  professed  to  give, 
surreptitiously  administered  these  alkaloid  prin- 
ciples, which  could  be  given  in  minute  doses,  and 
produce    marked    results.     A    sect   which    had 
started  upon  a  new  hypothesis,  presenting   so 
many  points  of  favor  with  the  public,  did  not  in- 
tend to  lose  these  advantages  by  any  concessions 
of  the  inability  of  their  infinitesimals  to  produce 
marked  and  visible  effects  upon  the  systems  of 
their  patients.     Where    infinitesimal  doses   did 
not  succeed,  the  alkaloids,  most  frequently  ad- 
ministered by  their  own  hands  in  full  doses,  pro- 


CONCENTRATED    MEDICINES.  119 

duced  certain  and  marked  results,  tlms  present- 
ing to  the  public  an  apparent  confirmation  of  the 
soundness    and    truthfulness    of  their  dogmas. 
This  system  of  medication  immediately  gained 
favor   with   the   delicate,  the   nervous,  the  fas- 
tidious.    Many  of  the  older   practitioners  who 
had  become  routinists  did  not  attempt  to  investi- 
gate these  causes  of  success,  or  use  the  new  rem- 
edies which  science  had  presented  to  them,  but 
continued  to  administer  the  old  and  nauseous 
medicines,  thus  driving  many  of  their  best  pa- 
tients into  the  hands   of  the  homoeopaths.     In 
those  preparations  which  could  be  taken  with  but 
little  taste,  most  persons  believed  that  there  was 
but  little  real  medicine,  and  boasted  to  their  for- 
mer physicians  of  the  minuteness  of  the  dose 
which  now  affected  them,  little  thinking  that  fre- 
quently in  the  small  quantity  was  concealed  treble 
the  medicinal  power  which  they  previously  took 
in   large  quantity.     Thus   the   assertion   of  the 
homoeopaths  that  they  administered  less  medi- 
cine than  the  other  physicians,  and  much  less 
than  was  formerly  given,  was  in  fact  a  falsehood ; 
for  by  calculating  the  amount  of  active  principle 
given  within  a  specified  time,  it  was  found  to  ex- 
ceed the  amount  of  the  same  principle  contained 
in  the  crude  material  formerly  used.     There  can 
be  no  question  that  the  innocent  dupes  of  homoeop- 
athy are  constantly  dosed  with  powerful  medi- 
cines, which  make  them  perpetual  patients.     In 
homoeopathic  families  the   habit   of  dosing  be- 


120  CONCENTRATED   MEDICINES. 

comes  permanent  to  the  infinite  injury  of  all  the 
members,  but  especially  to  the  young  and  sus- 
ceptible. This  practice  tends  to  but  one  result, 
viz.,  constant  minor  ailments  which  ultimately 
lead  to  prolonged  medical  attendance  and  large 
fee  bills.  It  is  a  demonstrable  fact  that  patients 
who  have  left  their  old  medical  attendants,  and 
placed  themselves  under  the  care  of  homoeopaths, 
have  had  much  more  sickness  than  before,  and 
have  more  than  quadrupled  the  amount  of  their 
expenses.  The  number  of  alkaloids  and  active 
principles  that  have  been  discovered,  though  nu- 
merous, do  not  j>resent  remedies  for  all  cases. 
Therefore  in  some  instances  the  whole  medicinal 
substance  or  plant  is  still  used  by  physicians. 
But  this  can  not  be  done  by  homoeopaths,  be- 
cause they  have  promised  the  public  minute  and 
almost  tasteless  remedies.  When,  therefore, 
cases  are  presented  to  them  that  can  not  be 
reached  by  these  new  remedies,  the  patient  must 
and  does  suffer  a  longer  and  more  dangerous 
sickness.  If  he  recovers,  his  convalescence  is 
tedious,  with  complications  which  might  have 
been  prevented  by  appropriate  treatment  at  an 
early  stage  of  the  disease.  But  with  the  nu- 
merous fallacies  of  the  system  of  homoeopathy 
we  have  nothing  at  present  to  do.  It  was  our 
present  purpose  simply  to  answer  the  oft-re- 
peated assertion  that  homoeopathy  has  taught 
regular  physicians  to  use  less  medicine,  and  also 
to  refute  the  error  that  homoeopaths  use  less 


CONCENTEATED    MEDICINES.  121 

medicine  than  educated  practitioners.  Briefly, 
then,  we  gladly  acknowledge  and  rejoice  that  all 
educated  physicians  use  less  medicine,  and  less 
nauseous  medicine  than  formerly,  but  this  re- 
sult has  been  brought  about  by  physiological  and 
pathological  investigations.  Theories  have  given 
place  to  facts,  and  improved  methods  of  diag- 
nosis have  taught  clearly  what  we  have  to  cure. 
A  better  understanding  of  therapeutics  has 
taught  us  the  application  of  remedies  to  the  cure 
of  diseases,  and  an  improvement  in  chemistry  has 
given  us  remedies  of  definite  and  certain  power. 
At  no  period  in  the  history  of  medicine  has  the 
practitioner  occupied  such  vantage-ground  as  to- 
day. He  can  determine  as  never  before  the  ex- 
act stage  of  progress  of  the  disease,  and  select 
his  remedy  with  the  precision  that  a  mechanic 
selects  his  tools  for  a  given  task.  And  these 
remedies  are  veritable  and  potent,  and  not  the 
flimsy  pretexts  obtained  by  the  mysterious  pro- 
cess of  shaking  a  bottle.  Let  us,  therefore,  main- 
tain the  position  firmly,  that  whatever  improve- 
ments have  been  made  in  the  art  of  prescribing, 
are  not  due  to  the  teachings  of  empiricism,  but 
,  are  the  fruits  of  science. 


XXIII. 
MECHANICAL    SUEGEEY. 


SURGERY  has  not  made  more  rapid  advances 
in  the  conservation  of  limbs  hitherto  doomed 
to  destruction,  than  has  mechanical  surgery  in 
supplying  the  defective  parts.  It  is  quite  im- 
possible, nowadays,  to  determine  what  part  of  an 
individual  is  natural,  and  what  artificial.  Of  ten 
men  who  walk  the  street  each  with  an  artificial 
leg,  in  nine  we  are  more  liable  to  fix  the  disa- 
bility upon  the  natural  than  the  artificial  limb. 
The  western  bride  who  was  thrown  into  con- 
vulsions on  seeing  her  bridegroom  suddenly  de- 
prived of  an  entire  leg  by  a  waggish  friend,  illus- 
trates in  one  of  a  thousand  ways  the  present 
perfection  of  the  appliances  of  mechanical  sur- 
gery. We  now  have  artificial  teeth  which  baffle 
even  dentists  to  detect  their  genuineness ;  and 
artificial  eyes  which  flash  with  intelligence, 
sparkle  with  merriment,  and  doubtless  roll  with 
the  fine  fancy  of  the  poet.  Even  nasal  append- 
ages are  now  manufactured  to  order  so  as  to 
imitate  exactly  the  natural  tint  of  that  organ,  or 
the  more  brilliant  colors  of  the  acne  rosacea 
(brandy  nose)  not  infrequent  in  the  higher  cir- 
cles of  society.     But  mechanical  surgery  is  only 


MECHANICAL   SURGERY.  123 

in  its  infancy  ;  most  of  the  improvements  which 
we  witness  date  back  but  a  score  and  a  half  of 
years.  The  clumsy  apologies  for  legs  which  fif- 
teen years  ago  represented  the  highest  degree  of 
art,  would  not  be  sold  by  any  respectable  manu- 
facturer of  our  time.  The  same  is  true  of  arti- 
ficial hands,  trusses,  etc.  The  genius  of  American 
invention  once  directed  to  this  fertile  field  for  use- 
ful and  profitable  effort,  there  is  no  limit  to  the 
advances  which  it  will  make.  Already  in  the 
treatment  of  deformities,  mechanical  appliances 
are  accomplishing  results  which  lead  us  to  antici- 
pate that  they  will  yet  monopolize  this  entire  field 
of  practice.  Mechanical  surgery  is  a  legitimate 
branch  of  the  healing  art.  Whatever  unprofes- 
sional men  may  have  accomplished  in  the  way  of 
invention  in  any  of  its  departments,  has  for  the 
most  part  been  the  result  of  accidental  circum- 
stances. A  farmer,  annoyed  by  a  hernial  pro- 
trusion, has,  sitting  at  the  side  of  his  plow, 
whittled  a  block  into  a  form  that,  when  applied, 
answered  its  purpose  well.  It  is  often  alleged  in 
recommendation  of  an  artificial  leg  that  the  in- 
ventor had  an  amputated  limb,  which  directed 
his  attention  to  this  special  study,  and  led  to  the 
invention  of  the  limb  in  question.  But  mechan- 
ical surgery  is  not  a  simple  branch  of  mechanics, 
to  which  any  ingenious  artisan  can  successfully 
turn  his  attention ;  it  requires  also  an  accurate 
knowledge  of  anatomy,  of  physiology,  and  of  sur- 
gery.    Rationally,  the  mechanical  surgeon,  or  the 


12  i  MECHANICAL   SURGERY. 

"  surgeon  artist,"  to  use  an  elegant  phrase,  must 
be  a  thoroughly  educated  physician  as  well  as  an 
inventive  genius.  A  man  might  with  as  much 
propriety  prescribe  remedies  without  a  knowledge 
of  diseases  as  undertake  to  apply  properly  a  truss 
without  a  knowledge  of  the  anatomy  of  the  mal- 
ady. The  same  remark  is  true  of  every  branch 
of  mechanical  surgery.  Quackery  in  this  de- 
partment, or  the  pretensions  of  uneducated  and 
unqualified  men,  are  as  gross  and  unmitigated 
as  in  the  simple  practice  of  physic.  The  medi- 
cal profession  have  too  long  regarded  mechanical 
surgery  as  the  legitimate  province  of  non-medi- 
cal men,  or  medical  speculators  in  patents.  This 
has  tended  powerfully  to  deter  worthy  and  com- 
petent medical  men  from  adopting  any  branch  of 
it  as  a  specialty,  and  thus  the  art  has  been  until 
recently  almost  monopolized  by  the  merest  pre- 
tenders. But  medical  men  of  real  merit  have  re- 
cently entered  this  field  of  service,  and  already  the 
ripe  fruits  of  skilled  labor  begin  to  appear.  We 
now  see  in  every  department  the  results  of  long 
and  careful  study  of  the  anatomical  or  patho- 
logical abnormalities  to  which  appliances  are 
adapted.  From  medically  educated  mechanical 
surgeons  the  profession  may  obtain  many  prac- 
tical hints,  and  it  is  important  that  we  have  a 
class  of  artisans  in  these  several  branches  to 
whom  we  may  with  confidence  refer  questions  of 
practice.  The  place  of  election  for  amputation 
of  the  lower,  and  even  the  upper  extremity,  should 


MECHANICAL   SURGERY.  125 

always  be  decided  by  the  mechanical  surgeon, 
and  hence  how  important  it  is  that  he  be 
thoroughly  qualified  to  give  a  just  decision. 
But  we  need  not  multiply  examples  of  this  kind. 
It  must  be  evident  to  every  one  that  mechanical 
surgery  is  a  branch,  and  a  most  desirable  branch 
of  surgical  science  and  art.  As  such  it  should 
be  fostered  by  the  profession  by  every  proper 
means.  First,  we  should  encourage  educated 
medical  men  to  engage  in  its  several  depart- 
ments as  special  objects  of  study  and  practice, 
and  then  give  them  the  most  cordial  support.  If 
the  profession  recognize  the  claims  of  this  branch 
of  the  healing  art,  and  take  under  its  protection 
those  who  devote  themselves  to  it,  there  will  be 
no  need  of  patents  to  insure  to  an  inventor  the 
honest  proceeds  of  his  labor  and  study.  Second, 
we  should  discountenance  on  all  occasions,  and 
under  all  circumstances,  the  uneducated  pre- 
tenders in  this  department  of  surgery,  who  throng 
our  cities  and  hawk  their  wares  in  every  mar- 
ket. Whatever  merit  some  may  have  as  in- 
ventors, as  a  class  they  are  not  entitled  to  the 
slightest  consideration,  and  should  meet  with 
unqualified  condemnation.  They  not  only  do 
great  harm  by  their  competition  with  qualified 
manufacturers,  but  too  frequently  their  appliances 
do  fatal  mischief  to  deformed  limbs. 


XXIV. 
COLOE    BLINDNESS. 


JOHN  DALTON,  an  English  chemist,  relates 
that,  when  a  boy,  he  went  to  see  a  review 
of  troops,  and  was  quite  surprised  at  hearing 
his  companions  speak  admiringly  of  the  red 
coats  of  the  soldiers  and  the  purple  sashes  of 
the  officers,  when  he  could  not  discover  any  dif- 
ference between  the  color  of  their  coats  and  the 
grass  in  the  field.  His  inquiry  of  his  comrades 
as  to  what  difference  they  could  see  was  received 
with  so  much  laughter  and  ridicule,  that  he  was 
led  to  believe  that  there  was  something  peculiar 
about  his  own  vision.  Subsequent  observations 
revealed  to  him  that  he  could  not  distinguish 
pink  from  blue,  and  in  the  solar  spectrum  he 
could  scarcely  discern  the  red,  it  appearing  to 
consist  of  two  colors,  yellow  and  blue.  He  after- 
ward, about  1798,  published  an  account  of  his 
case,  which  attracted  much  attention,  and  led  to 
further  investigation.  It  was  soon  found  that 
many  persons  were  similarly  affected,  in  a  great- 
er or  less  degree.  The  affection  was  called  Dal- 
tonism, and  those  suffering  from  it  were  called 
Daltonians.  The  subject  has  latterly  been  very 
thoroughly  studied,  and  it  has  been  found  to  be  a 


COLOK  BLINDNESS.  127 

very  common  defect  of  -vision,  though,  unless  ex- 
isting in  a  marked  degree,  it  does  not  always  at- 
tract attention.  Dalton  was  informed  of  nearly 
twenty  persons  with  vision  like  his  own ;  and  out 
of  twenty-five  pupils  he  once  had,  to  whom  he  ex- 
plained the  subject,  two  were  found  color-blind, 
and,  on  another  similar  occasion,  one.  Prevost 
was  of  the  opinion  that  of  every  twenty  men 
assembled  by  chance,  one  would  be  color-blind. 
Wilson  made  extensive  inquiries,  and  found  an 
average  of  one  person  in  seventeen  affected.  In  an 
examination  of  1,154  persons,  it  appeared  that 
one  in  fifty-five  confounded  red  with  green ; 
one  in  sixty  brown  with  green  ;  and  one  in  forty- 
six  blue  with  green.  The  defect  is  much  more 
marked  in  some  than  in  others.  Distinguish- 
ed men  like  Dugald  Stewart,  Sismondi,  and 
others,  have  exhibited  this  singular  peculiarity  of 
vision.  The  mistakes  which  color-blind  persons 
make  are  often  ludicrous.  A  member  of  the 
Society  of  Friends  purchased  for  himself  a  bottle- 
green  coat,  intending  to  select  a  brown  color,  and 
for  his  wife  a  scarlet  merino  dress  for  a  dark  one. 
A  minister  of  the  same  Society  selected  scarlet 
cloth  as  the  material  for  a  new  coat.  It  has 
been  alleged  that  many  of  the  followers  of 
George  Fox  wrere  color-blind.  A  journeyman 
tailor  was  promoted  to  the  position  of  foreman, 
where  he  had  to  match  colors,  and  wTas  soon  in- 
volved in  difficulty.  The  scarlet  back  of  a  livery 
waistcoat  was   provided  with   green   strings  to 


128  COLOR   BLIXDNESS. 

match;  a  ruddy  brown  was  put  side  by 'side  with 
a  dark  green ;  in  general,  lie  confounded  reds 
and  browns,  and  crimson  and  blue.  An  artist 
painted  a  brown  horse  bluish  green,  and  roses 
blue.  A  farmer  could  not  distinguish  red  apples 
from  the  surrounding  leaves,  except  by  their 
shape.  An  engraver  found  this  defect  of  vision 
useful.  He  says  :  "  When  I  look  at  a  picture,  I 
see  it  only  in  white  and  black,  or  light  and  shade  ; 
and  any  want  of  harmony  in  the  coloring  of  a 
picture  is  immediately  made  manifest  by  a  cor- 
responding discord  in  the  arrangement  of  its 
light  and  shade,  or,  as  artists  term  it,  the  effect." 
Color-blindness  may  be  congenital  (from  birth) 
or  it  may  be  acquired.  When  congenital,  it  is 
generally  hereditary,  and  may  often  be  traced 
through  a  number  of  generations.  Like  other 
hereditary  peculiarities,  it  frequently  passes  over 
one  or  two  generations,  and  then  appears  in  all 
its  intensity.  It  is  far  more  often  noticed  in  the 
male  than  the  female  members  of  a  family.  The 
causes  of  this  defect  of  vision  are  not  well  un- 
derstood. When  congenital,  it  is  supposed  to 
be  due  to  a  defect  in  the  organization  of  the 
brain,  at  the  point  where  is  located  the  sense  of 
sight.  Phrenologists  assert  that  the  organ  of 
color  is  located  immediately  above  the  middle  of 
the  eyebrow,  and  they  claim  to  find  at  this  point 
in  the  color-blind  a  marked  depression.  It  is 
said  that  Mr.  Kansome,  who  is  no  phrenologist, 
states,  as  a  fact  noticed  in  the  dissection  of  Dal- 


COLOK  BLINDNESS.  129 

ton,  "  that  there  was  a  marked  deficiency  in  tlie 
convolutions  of  the  brain  over  the  orbitar-plates, 
which  are  assigned  to  the  organ  of  color." 
It  is  remarked  by  Wilson  that  there  is  doubtless 
a  great  difference  in  original  endowment  in  re- 
gard to  the  sense  of  color  among  nations.  People 
who  live  under  bright  skies,  and  among  plants 
and  animals  of  vivid  and  brilliant  colors,  exhibit 
skill  in  arranging  and  harmonizing  tints  which 
would  seem  to  prove  that  they  are  not  afflicted 
with  color-blindness.  The  Chinese,  Japanese, 
Venetians,  Italians,  Spaniards,  and  the  inhabit- 
ants of  Southern  France,  have  for  centuries  ex- 
celled as  florists,  painters,  dyers,  glass  and 
porcelain  makers  and  stainers.  On  the  contrary, 
the  nations  of  northern  climates,  where  the  sum- 
mers are  short  and  the  winters  long  and  gloomy, 
and  all  colors  are  subdued,  have  but  little  regard 
to  the  colors  of  their  dress  and  household  adorn- 
ments, and  hence  color-blindness  is  probably  not 
infrequent.  When  the  disease  is  acquired,  it  de- 
pends upon  some  temporary  disturbance  of  the 
system  affecting  the  circulation.  When  congeni- 
tal, the  defect  is  permanent,  and  persons  suffering 
from  it  must  adapt  their  business  to  this  peculi- 
arity of  their  vision.  They  should  never  engage 
in  any  occupation  where  this  defect  of  vision 
would  involve  the  lives  of  others,  as  in  the  use  of 
signals. 

6* 


XXV. 
LITERATURE    IN   MEDICINE. 


THERE  is  an  anecdote  current  that  a  New 
York  physician,  recently  traveling  abroad, 
met  a  distinguished  Parisian  surgeon,  to  whom 
he  spoke  in  somewhat  laudatory  terms  of  his  pre- 
ceptor. "  What  has  he  done  ?"  was  the  prompt 
inquiry  of  the  foreigner,  adding,  "  I  don't  remem- 
ber to  have  read  any  of  his  writings."  "It  is 
true,  he  has  never  written  anything,"  replied  the 
puzzled  American,  "  but  then  he  has  a  very  large 
business."  "  And  is  that  the  standard  by  which 
you  estimate  professional  excellence?"  retorted 
the  surgeon,  with  look  and  gesture  expressive  of 
contempt.  There  is  in  this  incident  a  world  of 
meaning.  It  sets  forth  vividly  a  national  trait  in 
our  profession,  which  disgraces  us  individually 
and  as  a  body.  We  are  proud  of  being  called 
practical,  having  no  time  to  write,  on  account  of 
the  severe  pressure  of  our  business  engagements. 
The  young  man,  who,  after  being  located  half-a- 
dozen  years  in  practice,  still  goes  on  foot,  is  set 
down  as  a  failure.  There  is  no  hope  of  his  ever 
rising  to  a  level  with  the  aristocracy  of  his  pro- 
fession. It  matters  little  what  may  be  his  scien- 
tific attainments  or  his  moral  worth  ;  he  is  an 


LITERATURE  IN  MEDICINE.  131 

object  of  pity,  if  not  of  contempt.  Men  in  high 
and  influential  positions  frequently  boast  of  their 
incomes,  and  exhibit  their  list  of  daily  calls,  or 
their  bank-books,  as  an  evidence  of  success. 
Half  of  the  gossip  in  professional  circles  relates 
to  the  income  of  individuals.  These  false  ideas 
of  professional  success  have  taken  deep  root 
among  us,  and  are  bearing  bitter  fruits.  The  re- 
cent graduate  is  driven  to  seek  business  as  the 
first  great  desideratum.  He  abandons  the  pur- 
suit of  special  studies,  for  which  he  may  have  a 
predilection,  because  they  will  not  immediately 
"  pay."  He  can  not  afford  to  labor  patiently  in 
the  pursuit  of  knowledge,  and  let  business  come 
as  its  sweet  reward.  Like  Ortugal,  he  demands 
that  "  the  golden  stream  be  quick  and  violent." 
If  patients  do  not  immediately  seek  him,  he  goes 
out  into  the  highways  and  byways  and  compels 
them  to  come  in.  At  all  hazards  he  must  have 
the  appearance  of  business.  Urged  on  by  this 
infatuation,  he  assumes  all  the  externals  of  suc- 
cess. His  mode  of  living,  and  his  equipage,  are 
often  far  beyond  his  income,  but  he  lives  in  the 
hope  that  these  glittering  baubles  will  advance 
his  business,  and  in  the  end  reimburse  his  outlay. 
He  may  attain  the  summit  of  his  ambition,  and 
acquire  the  largest  practice  in  the  community ; 
but  it  is  not  improbable  that  he  will  sadly  fail. 
But,  whether  he  succeeds  or  not,  he  is  lost  to  the 
science  of  his  profession.  He  may  seek  positions 
in  hospitals,  schools,  and  societies,  as  collateral 


132  LITERATURE   IN   MEDICINE. 

aids  to  success,  but  in  every  position  lie  is  a  non- 
entity. His  name  may  be  trumpeted  throughout 
the  world,  but  no  man  of  education  will  even  rec- 
ognize it.  He  dies,  and  leaves  behind  him  no 
memorial  but  the  perishable  marble.  A  short 
generation  passes  from  the  stage,  and  his  memory 
is  swept  forever  from  the  earth.  It  is  time  the 
profession  of  this  country  set  up  a  higher  stand- 
ard of  merit  than  that  now  so  generally  adopted. 
We  should  pay  homage  only  to  genuine  worth. 
The  palm  of  excellence  should  be  given  to  him 
who  has  the  profoundest  practical  knowledge  of 
the  science  and  art  of  medicine,  and  who  makes 
that  knowledge  available  to  others.  As  a  pro- 
fession, we  should  not  only  cultivate  science,  but 
we  should  also  cultivate  literary  taste.  History 
and  observation  prove  the  truth  of  Zimmermann's 
remark — •"  that  the  greatest  medical  writers  of  any 
age  were  the  best  physicians."  We  have  no  right 
to  ridicule  the  man  who  frequently  communicates 
his  views  to  the  profession.  While  it  is  true  that 
too  many  write  who  have  nothing  worthy  of  pub- 
lication, it  is  sadly  true  that  many  who  fill  high 
places  withhold  altogether  their  experience  from 
their  brethren.  There  are  in  this  and  other  com- 
munities too  many  of  this  latter  class.  They  are 
intellectually  and  morally  worthy  of  the  confi- 
dence of  the  profession,  and  capable  of  being  the 
leaders  in  the  department  of  practice  to  which 
they  are  especially  devoted.  By  virtu )  of  true 
merits  they  have  obtained  responsible  positions 


LITERATURE  JN   MEDICINE.  133 

in  our  hospitals,  schools,  and  associations,  and 
are  qualified  by  long  experience  and  sound  judg- 
ment to  instruct.  It  is  to  them  that  the  profes- 
sion look  for  sound  instruction  in  practical  medi- 
cine, surgery,  and  obstetrics,  and  for  a  just 
estimate  of  the  value  of  the  more  recent  improve- 
ments. But  they  are  sealed  books  that  give  no 
information.  They  are  quick  to  turn  every  ad- 
vantage which  official  position  may  have  given 
them  to  their  personal  and  pecuniary  account, 
but  they  make  no  return  to  those  who  have  raised 
them  to  power.  They  will  have  their  reward  in 
that  utter  oblivion  which  is  hereafter  to  cover 
their  names.  The  close  of  a  life  so  destitute  of 
substantial  results,  where  large  opportunities  for 
usefulness  have  been  neglected,  or  used  only  for 
selfish  purposes,  ought  to  excite  pity  and  con- 
tempt. But  we  have  become  so  accustomed  to 
rate  that  man  successful  who  obtains  the  largest 
practice  and  accumulates  the  most  wealth,  that  it 
is  difficult  to  fix  a  higher  standard  of  greatness 
in  this  country.  We  are,  however,  hopeful  of 
the  coming  generation  of  medical  men ;  they 
are  in  general  far  better  qualified  by  a  prelimi- 
nary education  ;  they  have  fixed  habits  of  study 
and  investigation ;  they  have  more  culture  and 
refinement,  and  are  thoroughly  imbued  with  the 
spirit  of  progress  and  improvement. 


XXVI. 
FEMALE    NURSES  IN  HOSPITALS. 


T  is  conceded  that  woman  may  be  employed 
"  as  the  regular  administrator  of  the  pre- 
scribed medicines,"  and  that  she  is  more  capable 
than  the  opposite  sex  of  those  "  delicate,  soothing 
attentions  which  are  always  so  grateful  to  the 
sick."  This  has  already  been  proved.  "Well- 
trained  nurses  generally  win  the  good  opinions 
of  the  very  physicians  who  at  first  are  opposed 
to  their  admission.  Says  an  observer  in  a  mili- 
tary hospital :  "  The  presence  of  these  ladies  has 
demonstrated  that  there  are  numberless  little 
things  essential  to  the  comfort  of  the  sick,  which 
not  one  man  in  a  thousand  ever  thinks  of,  but 
which  woman  sees  by  intuition,  and  supplies  as 
if  by  magic."  We  doubt  not  it  will  also  be  ad- 
mitted that  she  is  better  adapted  than  man  to 
prepare  food  for  the  sick,  to  preserve  cleanliness 
of  the  wounds,  and  of  the  beds,  and  to  regulate 
and  keep  in  order  whatever  relates  to  the  domes- 
tic appointments  of  a  hospital.  Miss  Nightin- 
gale has  aptly  said  on  this  point :  "  I  think  the 
Anglo-Saxon  would  be  very  sorry  to  turn  women 
out  of  his  own  house,  or  out  of  civil  hospitals, 
hotels,  institutions  of  all  kinds,  and  substitute 


FEMALE   NUESES-IN   HOSPITALS.  135 

men  housekeepers  and  men  matrons.  The  con- 
trast between  even  naval  hospitals,  where  there 
are  female  nurses,  and  military  hospitals  where 
there  are  none,  is  most  striking,  in  point  of  order 
and  cleanliness."  There  can  be  few  who  will  not 
agree  with  her  in  the  opinion,  that  "  the  woman 
is  superior  in  skill  to  the  man  in  all  points  of 
sanitary  domestic  economy,  and  more  particu- 
larly in  cleanliness  and  tidiness  ;"  and  further, 
that  "  great  sanitary  civil  reformers  will  always 
tell  us  that  they  look  to  the  woman  to  carry  out 
practically  their  sanitary  reforms."  What  then 
are  the  objections  to  the  employment  of  female 
nurses  in  general  hospitals  ?  We  are  not  aware 
what  plan  will  be  adopted  in  hospital  practice 
nor  what  special  duties  will  be  assigned  to 
female  nurses,  if  they  are  employed  ;  but  we  know 
from  personal  knowledge,  that  the  objections 
raised  are  rather  imaginary  than  real  in  a  hos- 
pital that  has  a  proper  organization.  Let  us  re- 
cur to  experience.  It  was  our  fortune  to  spend 
a  portion  of  our  medical  pupilage  as  resident  in 
a  hospital  which  was  entirely  under  the  super- 
vision of  women.  This  hosrjital  was  general  in 
its  character,  admitting  all  classes  of  patients, 
medical  and  surgical,  and  of  both  sexes.  During 
this  period  cholera  prevailed  in  the  town,  and 
the  sick  of  this  disease  crowded  the  wards.  The 
general  management  was  under  the  direction  of 
a  matron  who  had  for  years  been  an  experienced 
hospital  nurse.     Subordinate  to  her  were  six  chief 


136  FEMALE   NURSES   IN    HOSPITALS. 

nurses.  These  nurses  were  educated,  intelligent, 
and  refined,  and  many  of  them  were  from  the 
highest  ranks  of  society.  They  were  skilled 
nurses.  They  adopted  this  employment  from 
strong  religious  convictions  of  duty,  and,  enter- 
ing upon  it  as  a  life-work,  submitted  to  thorough 
preparation  by  systematic  training.  The  division 
of  labor  was  as  follows  :  one  had  entire  charge  of 
the  culinary  department,  a  second  of  the  laundry, 
and  the  remaining  four  of  the  several  medical 
and  surgical  divisions  of  the  wards.  Under  their 
immediate  supervision,  therefore,  was  the  prepa- 
ration of  the  diet,  the  washing  of  the  clothes  and 
bedding  of  patients,  the  administration  of  medi- 
cines, and  all  minor  dressings.  There  was  also 
the  usual  number  of  visiting  physicians  and  sur- 
geons, and  a  resident  medical  student.  Although 
there  was  but  a  single  male  attendant,  assist- 
ance was  always  to  be  obtained  among  the  con- 
valescents. The  administration  of  the  medicines 
was  never  committed  to  assistants,  nor,  indeed, 
any  of  the  details  of  nursing.  Surgical  dressings 
of  a  delicate  character  were,  of  course,  under  the 
immediate  charge  of  the  resident  physician,  and 
the  assistance  of  male  patients  from  their  beds 
was  the  proper  duty  of  the  orderly.  During  a 
residence  of  a  year  in  this  institution,  we  never 
knew  the  slightest  indecencies  on  the  part  of 
male  patients  toward  their  nurses,  nor  were  the 
latter  ever  placed  in  a  position  embarrassing  to 
one  unaccustomed  to  the  daily  duties  of  hospital 


FEMALE   NUESES_IN   HOSPITALS.  137 

ward?.  On  the  contrary,  the  patients  enter- 
tained the  most  profound  respect  for  the  nurses, 
the  convalescents  volunteering  with  the  utmost 
alacrity  to  aid  them  in  their  duties.  In  regard 
to  thai;  hospital,  we  speak  but  the  unanimous 
sentiment  of  every  physician  and  surgeon  con- 
nected with  it  when  we  affirm  that  in  cleanliness 
of  wards  and  beds,  in  the  preparation  of  the  food 
for  the  sick,  in  the  precise  administration  of 
medicines,  in  watchful  care  at  the  bedside,  in  a 
a  word,  in  everything  pertaining  to  the  manage- 
ment of  the  domestic  and  medical  department 
of  a  hospital,  this  was  a  model  institution,  and 
one  which  has  no  equal  in  this  country.  And  if 
we  add  to  these  excellencies  the  thousand  little 
offices  of  kindness  which  woman  alone  knows 
how  to  bestow  upon  the  sick  and  suffering,  we 
need  not  be  surprised  that  many  a  patient  from 
that  hospital  was  heard  in  after  years  to  utter  a 
benediction  upon  his  former  nurses,  the  good 
Sisters  of  Charity  !  The  testimony  of  those  who 
have  seen  the  practical  working  of  the  system  of 
female  nursing  is  to  the  same  purport ;  and  as 
such  evidence  is  that  upon  which  we  must  rely  in 
coming  to  a  rational  conclusion,  we  shall  refer 
briefly  to  the  opinions  of  those  who  h  ave  h  ad  oppor- 
tunities for  extended  observation.  At  Guy's  Hos- 
pital, London,  there  were  no  male  nurses  in  1857, 
according  to  the  evidence  of  Mr.  Steele,  its  super- 
intendent. There  were  eighteen  chief  nurses, 
having  charge  of  the  day  and  night  nurses ;  of 


138  FEMALE   NURSES  IN   HOSPITALS. 

the  former  there  were  twenty-seven,  and  of  the 
latter  twenty-three.  The  duties  of  the  chief 
nurses  are  thus  stated  :  "  They  have  the  general 
superintendence  of  the  wards,  and  they  are  re- 
sponsible to  the  physicians  for  the  medicines  and 
wines,  and  for  the  cleanliness  of  the  patients  ; 
they  have  charge  of  the  ward  furniture  and  the 
bed-linen."  The  other  nurses  had  the  immedi- 
ate charge  of  the  patients.  In  reply  to  the  ques- 
tion, Does  your  system  of  nursing  work  well  ?  he 
answered :  "  Eemarkably  well."  The  only  im- 
provement suggested  was  the  employment  of  one 
or  two  orderlies  for  the  venereal  and  bad  sur- 
gical cases.  The  same  system  was  in  operation 
in  London  Hospital.  After  an  extended  investi- 
gation of  the  working  of  the  hospital  S3'stems  on 
the  continent,  Mr.  Alexander  gave  evidence  be- 
fore a  Parliamentary  Commission  as  follows  : 
"  From  what  we  saw  and  heard  of  the  female 
nursing  in  Paris  and  Brussels,  there  can  not  be  a 
doubt  that  good  results  would  follow  the  intro- 
duction of  a  certain  number  of  well-selected 
educated  nurses  to  our  hospital  establishments  • 
In  Jamaica,  in  1837, 1  recommended  female  nurs- 
ing to  be  employed,  from  what  I  saw  of  the  evil 
effects,  and  even  risk  of  life,  by  orderly  or  soldier 
nursing  in  severe  cases,  but  no  attention  was 
paid  then  to  my  recommendation  ;  and  from  my 
more  extended  experience,  I  am  still  more  con- 
vinced of  the  advantages  that  would  be  derived 
from  the  judicious  introduction  of  female  nursing 


FEMALE  NUESES_IN   HOSPITALS.  139 

into  our  permanent  hospital  establishments."  It 
appears  also,  that  at  the  time  this  investigation 
was  made,  the  French  emperor  was  forming  a 
corps  of  female  nurses  for  military  hospitals,  the 
selection  being  made  from  the  Sisters  of  Charity 
in  the  civil  hospitals.  During  the  Crimean  war 
female  nursing  in  military  hospitals  was  put  to  a 
practical  test,  and  the  opinions  of  those  who  wit- 
nessed its  efficiency  are  worthy  of  especial  con- 
sideration. Dr.  Parkes,  who  had  charge  of  the 
Eenkioi  Hospital,  says  :  "  I  have  a  Very  high 
opinion  of  female  nurses,  if  they  have  been 
trained  and  are  proper  nurses."  Mr.  Meyer, 
Medical  Director  of  the  Civil  Hospital  at  Smyrna, 
states  that  "  they  worked  uncommonly  well ;  out 
of  twenty-two  female  nurses  only  one  was  re- 
moved for  any  misconduct Several 

of  the  ladies  that  we  had  did  the  work  uncom- 
monly well,  and  it  would  have  been  very  difficult 
to  have  got  a  larger  class  of  severe  cases  of  fever 
attended  to  so  well  by  night  and  day  except  by 
the  agency  of  those  ladies,  who  were  thoroughly 
to  be  relied  on,  not  only  from  their  superior  intel- 
ligence but  their  devotion  to  the  work."  But  we 
-  need  not  multiply  this  testimony,  for  we  require 
no  further  arguments  or  evidence  to  prove  the 
importance  of  employing  qualified  female  nurses 
in  civil  and  military  hospitals. 


XXVII. 
MATERNAL    VIGILANCE, 


IT  is  said  that  Sir  Edward  Codrington,  when 
a  young  officer  at  Toulon,  was  so  anxious 
to  distinguish  himself  that  he  passed  the  greater 
part  of  the  day  on  deck,  watching  for  signals  to 
give  intelligence  of  the  movements  of  the  French 
vessels,  and  when  he  retired,  he  sank  into  a  sleep 
so  profound  that  the  loudest  noise  did  not  awake 
him  ;  but  when  the  word  "  signal"  was  whispered 
in  his  cabin,  he  immediately  sprang  up.  This 
anecdote  proves  how  sleepless  in  the  midst  of 
the  profoundest  slumbers  is  that  faculty  of  the 
mind  which  for  the  time  being  is  intensely  excited. 
The  same  truth  is  well  illustrated  in  the  case  of 
the  mother.  She  is  the  most  sleepless  person  in 
the  household.  For  months,  and  often  for  years, 
she  does  not  enjoy  two  consecutive  hours  of 
sleep.  But  it  is  not  the  noises  in  the  street,  nor 
anxiety,  nor  nervousness,  that  disturb  her  repose. 
She  can  sleep  soundly  when  others  are  made 
wakeful  by  unusual  sounds  or  voices.  But  there 
is  one  sound,  one  voice,  more  potent  in  her  ears 
than  all  others:  it  is  the  voice  of  her  child. 
When  that  is  heard,  even  in  the  faintest  whisper, 
she  arouses  from  the  deepest  sleep ;  however  in- 


METEKNAL   VIGILANCE. 


141 


sensible  she  may  be  to  other  voices,  that  one 
never  fails  to  be  heard  by  her  quick  ear.  Moth- 
ers often  relate  that  long  after  their  children 
have  grown  to  manhood  and  womanhood,  they 
are  startled  from  their  slumbers  by  the  old  and 
familiar  cries  of  their  babyhood.  This  instinct- 
ive wakefulness  of  the  mother  to  the  wants  of 
her  child  teaches  a  most  important  lesson  in  the 
care  of  children  at  night.  It  is  a  growing  prac- 
tice in  our  first-class  families  to  commit  the  in- 
fant to  the  care  of  the  nurse  at  night,  that  the 
mother  may  not  be  disturbed,  but  may  have  her 
regular  and  full  amount  of  sleep.  This  is  done 
under  the  pretence  that  the  mother's  health 
requires  that  her  night's  rest  should  not  be 
broken  by  the  care  of  the  child.  Except  in  ex- 
traordinary cases,  there  is  no  truth  in  the  asser- 
tion :  if  the  mother  and  child  are  in  ordinary 
health/ the  proper  care  of  her  infant  at  night 
does  not  tax  the  mother  beyond  her  strength  ; 
while  the  judicious  care  of  the  child  by  the 
mother  diminishes  greatly  the  irritability  and 
restlessness  of  the  former.  But  there  are  cer- 
tain positive  evils  and  dangers  attending  the 
care  of  the  infant  by  a  nurse  at  night.  It  will 
prove  in  nine  cases  out  of  ten,  that  the  nurse 
considers  her  own  sleep  of  paramount  impor- 
tance, and,  in  about  the  proportion  given,  it  will 
be  found  that  she  manages  to  obtain  it.  In  the 
first  place  her  affections  are  not  stimulated  by 
the  child,  and  hence  her  sympathies  are  not  en- 


142  MATEENAL    VIGILANCE. 

listed  in  its  care  and  welfare.     She  sleeps  quite 
unconscious   of    and   undisturbed  by   its   cries, 
when  its  plaintive  voice  penetrates  to  the  moth- 
er's ear,  though  in  a  distant  and  secluded  part  of 
the  house.    Thus  many  a  helpless  infant  that  has 
become  tired  of  lying  in  one  position,  and  merely 
requires  to  be  changed  to  secure  perfect  rest  and 
quiet,  cries  itself  asleep  from  sheer  exhaustion, 
unable  to  arouse  the  leaden  ears  of  its  nurse. 
One  of  the  first  and  most  dangerous  consequen- 
ces  of    committing    the    child    to   the   care   of 
the  nurse  at  night,  is  her  Hability  when  asleep 
to  over-lay  and  smother  it  without  hearing  its 
stifled    cries.     The    English    mortuary    records 
show  that   two  or  three   hundred   children  are 
thus  killed  annually.     But  if  the  child  escapes 
death   or  injury  from   this   cause,  it   is   by  no 
means  free  from  danger  from  other  sources.     It 
is  liable  to  be  habitually  drugged  to  sleep.     This 
may,  and  doubtless  will  be  regarded  by  many  as 
an  unjust  suspicion  upon  their  own  "faithful" 
nurses ;  but  there  are  too  many  facts  accumu- 
lated against  them  to  make  it  doubtful.     It  must 
be  assumed  as  a  truth  that  nurses  will  have  their 
own   usual   amount   of   sleep.     If  they  can  not 
obtain  it  on  account  of  the  restlessness  of  the 
child,  they  soon  learn  the  remedy  for  its  sleep- 
lessness.    They  try  it   secretly  and   cautiously, 
and  find  it  succeeds  perfectly ;  they  repeat  it  with 
equal  success  several  times  ;  and  now  made  bold 
and  confident,  they  administer  the  anodyne  with 


MATERNAL  VIGILANCE.  143 

liberal  hand  every  night,  or  at  least  when  they 
fear  the  child  will  disturb  their  own  slumbers. 
A  child  thus  treated  soon  becomes  unusually  irri- 
table and  peevish,  its  digestion  is  impaired,  its 
complexion  is  a  dirty,  sallow  hue,  it  suffers  from 
constipation,  and  finally  sleeps  soundly  only 
when  under  the  influence  of  its  accustomed  drug. 
How  many  children  in  every  wealthy  and  fash- 
ionable community,  with  good  native  constitu- 
tions, fall  into  premature  decay  from  this  cause 
it  is  impossible  to  determine ;  but  the  coroner's 
inquests  prove  that  many  infants  die  annually 
from  the  imprudent  use  of  the  drugs  constantly 
found  in  nurseries.  It  can  but  be  regarded 
as  an  axiom  of  the  utmost  importance  in  the 
rearing  of  children,  that  the  mother  should  have 
the  personal  charge  and  care  of  them  at  night. 
A  medical  writer  of  great  experience  says  :  "  How 
many  children  sleep  the  sleep  of  death  through 
the  undue  administration  of  carminatives  and 
other  nostrums !  It  requires  the  mother's  great- 
est vigilance  to  prevent  such  weapons  being  in- 
troduced into  the  nursery ;  for  a  nurse,  however 
otherwise  excellent,  is  apt  to  prefer  the  comfort 
of  uninterrupted  slumber  to  the  performance  of 
her  duty  in  studying  the  welfare  of  the  child 
committed  to  her  care."  This  advice  can  not  be 
too  frequently  repeated  by  the  physician  in  his 
daily  visits  among  the  wealthy  and  fashionable 
classes. 


XXYIII. 
A   SUSPENSE    OF    FAITH. 


A  DISTINGUISHED  leader  of  a  religious 
sect  characterized  by  its  disregard  of  the 
teachings  of  the  past,  its  rejection  of  all  forms, 
creeds,  ceremonies,  and  tangible  incitements  to 
devotion,  and  for  its  purely  spiritual  worship, 
recently  startled  the  world  by  the  announcement 
that  a  new  Church  was  required  to  meet  the 
religious  wants  of  mankind.  From  his  own 
stand-point  it  was  evident  to  him  that  there 
was  "  a  suspense  of  faith  "  among  Christians  ;  a 
prevalent  dissatisfaction  with  those  theological 
refinements  which  exalted  the  spiritual  at  the 
expense  of  the  material ;  a  certain  anxious  look- 
ing for  the  revelation  of  a  new  mode  of  worship. 
Regarding  man  as  a  finite  being,  having  senses 
through  which  he  is  to  gain  a  knowledge  of  the 
external  world,  and  in  all  his  pursuits  dealing 
with  substance  and  not  shadow,  with  material 
forms  and  not  essences,  he  very  rationally  con- 
cludes that  to  meet  the  religious  exigencies  of  at 
least  his  own  denomination,  they  should  return 
to  those  forms  of  worship  which  in  the  highest 
degree  stimulated  to  devotion  by  an  appeal  to 
the  senses.     Accordingly,  he  recommended  the 


A   SUSPENSE   OE  FAITH.  145 

establishment  of  a  Church  with  temples  of  the 
most  imposing  architecture,  with  altars  smoking 
with  burning  incense,  with  music  the  most  sol- 
emn, and  ceremonials  the  most  impressive.  This 
theological  philosopher,  though  advocating  the 
most  absolute  changes  in  his  own  sect,  reasoned 
from  true  premises,  and  came  to  logical,  rational 
conclusions.  Man  has  a  spiritual  and  material 
existence  so  intimately  blended,  and  mutually  so 
dependent,  that  the  one  contributes  constantly 
to  the  aid  of  the  other  in  their  normal  and 
healthy  action.  His  religious  being  can  not  long 
subsist  on  the  vagaries  of  the  imagination,  or 
the  airy  nothings  of  a  speculative  theology. 
Medicine,  like  theology,  has  its  transcendental 
worshipers.  Rejecting  the  methods  of  investi- 
gation by  which  every  other  science  is  advanced, 
they  adopt  a  dogma  at  once  irrational  and  insus- 
ceptible of  explanation,  and  upon  this  build 
up  a  theory  purely  imaginary.  Whatever  does 
not  square  with  this  theory  is  to  be  rejected, 
though  its  j>ractical  value  may  have  been  proved. 
The  acquired  knowledge  of  the  profession,  how- 
ever exact  and  true,  is  accounted  as  nothing,  un- 
less in  harmony  with  this  absurd  principle.  The 
history  of  medicine,  in  all  that  relates  to  its  ma- 
terial interest,  is  obliterated,  and  a  new  era 
commenced.  They  thus  discard  alike  the  accumu- 
lated experience  of  the  past,  the  discoveries  of 
the  present,  and  the  aids  by  which  nature  and 
art  are  made  to  subserve  the  interests  of  science. 


146  A   SUSPENSE   OF   FAITH. 

To  them  pathology  reveals  no  useful  facts  in  the 
history  of  disease,  and  the  microscope  and  or- 
ganic chemistry  are  cast  aside  as  useless  meth- 
ods of  investigation.  Withdrawing  from  the  pro- 
fane and  vulgar  touch  of  material  objects,  they 
seek  to  advance  their  knowledge  of  human  mal- 
adies by  studying  the  influence  of  intangible 
entities  upon  a  diseased  imagination.  Causes 
are  entirely  lost  sight  of,  in  their  anxiety  to  dis- 
cover agents  producing  like  results ;  symptoms 
are  ascribed  to  the  potency  of  the  ultimate  par- 
ticle of  inert  substances ;  and  the  physiological 
termination  of  diseases  is  attributed  to  the  elim- 
ination of  a  mythical  cause  by  fabulous  reme- 
dies. It  is  not  strange  that  an  inquiring  mind 
should  at  length  sicken  of  such  irrational  pur- 
suits, and  turn  from  this  pseudo-science  which 
has  only  a  retrograde  movement,  to  that  true 
science  which  daily  unfolds  new  and  hidden 
treasures  to  its  votaries.  It  is  only  marvelous 
that  an  educated  person  could  long  occupy  him- 
self with  studies  so  trivial,  and  investigations  so 
unscientific  and  deceptive.  We  can  only  ac- 
count for  it,  knavery  aside,  by  the  fact  that  med- 
icine, in  many  respects,  gives  the  greatest  lati- 
tude for  self-deception.  But  he  who  is  firmly 
established  in  correct  principles,  and  has  the 
support  of  a  sound  judgment,  can  maintain  his 
integrity  while  studying  its  most  obscure  chap- 
ters. We  have  ever  been  confident  that  edu- 
cated persons  adopting  a  system  so  destitute  of 


A   SUSPENSILOF   FAITH.  147 

merit,  would  finally  become  weary  of  its  hollow 
pretensions,  its  inability  to  progress,  and  the  un- 
satisfying nature  of  its  studies.  There  have 
long  been  striking  evidences  of  a  "  suspense  of 
faith"  among  the  practitioners  of  this  school. 
Discontent  pervades  its  rants,  exhibiting  itself 
in  a  universal  tendency  to  abandon  the  intan- 
gible, imponderable,  and  imperceptible  in  reme- 
dies— the  dogma  dear  to  the  heart  of  its 
founder.  Silently  many  have  returned  to  their 
old  faith,  while  the  majority  have  sadly  back- 
slidden, and  indulged  clandestinely  in  the  sin  of 
employing  old  curative  measures.  The  leaders 
have  endeavored  to  meet  this  exigency,  not  by 
affectionate  appeals  to  duty  or  stern  reprimands 
for  delinquencies,  but  by  devising  means  of  con- 
cealing from  public  recognition  the  real  defection 
of  their  followers.  Ingenious  methods  of  dis- 
guising full  doses  of  every  important  remedy 
seemed  for  a  time  to  answer  their  purpose  ;  but 
there  was  a  limit  even  to  this  device.  Aloes  and 
assafcetida  could  thus  be  administered  in  large 
doses  without  detection ;  but  by  what  means 
could  blisters,  leeches,  and  the  lancet,  so  long,  so 
"  loudly,  and  so  persistently  denounced,  be  used, 
without  utterly  destroying  the  fabric  which  had 
been  raised  with  so  niuch  labor  and  art !  Even 
this  point  seemed  to  have  been  attained.  A  dil- 
igent inquirer  set  to  work  to  determine  upon 
what  principles  these  three  remedies  acted; 
when,  to  the  astonishment  of  himself  and  friends, 


148  A   SUSPENSE   OF  FAITH. 

lie  discovered  that  blisters  and  leeches  acted 
purely  according  to  the  dogma  of  their  school, 
and  therefore  were  to  be  boldly  employed.  He 
also  further  ventured  the  assertion,  that  venesec- 
tion would  doubtless  be  found  to  act  upon  the 
same  principle,  if  its  action  were  thoroughly  in- 
vestigated, when  the  lancet  would  also  be  recog- 
nized as  a  legitimate  resort  in  acute  diseases. 
Here  was  a  total  abandonment  of  everything  but 
the  name,  which  has  long  passed  for  nothing. 
But  even  these  concessions  and  compromises,  it 
now  appears,  will  not  answer  the  exigencies  of 
that  school.  The  flimsy  subterfuges  which  it 
raises  will  not  long  suffice  to  cover  its  nakedness. 
The  larger  body  of  its  members  require  a  new 
faith,  and  that  faith  will  be  rational,  scientific 
medicine.  Medicine,  like  theology,  has  had  its 
isms,  which  have,  in  various  ways,  and  by  multi- 
plied deceptive  charms,  and  insidious  influences, 
enticed  its  members  from  its  ranks.  The  history 
of  medicine  presents  a  continued  series  of  pop- 
ular theories,  which  have  for  the  time  engrossed 
the  attention,  and  then  fallen  into  contempt. 
No  age,  however  enlightened,  can  claim  exemp- 
tion from  the  prevalence  of  medical  heresies, 
but  we  may  console  ourselves  with  the  reflection 
that  medicine  also,  like  theology,  has  always  had 
its  true  Church,  to  which  the  footsteps  of  every 
honest  seeker  after  truth  finally  tend,  however  far 
he  may  have  wandered  from  the  paths  of  recti- 
tude. 


XXIX. 
THE    PHYSICIAN   AS    CITIZEN. 


UNDOUBTEDLY,  medicine,  whether  con- 
sidered as  a  science  or  an  art,  in  its  study 
or  in  its  practice,  is  the  most  noble  and  honorable 
profession  which  man  can  follow.  Such  at  least 
is  the  opinion  of  medical  men,  and  there  are  few 
learned  and  considerate  persons  of  any  other 
pursuit  who  do  not  yield  it  equal  homage.  In- 
deed, no  liberal  mind,  familiar  with  the  range  of 
natural  sciences  which  medicine  comprehends, 
the  ennobling  and  liberalizing  effects  of  its  study, 
and  above  all,  the  humane  objects  which  its  prac- 
tical application  to  man's  physical  necessities 
contemplates,  can  but  regard  it  as  a  profession  of 
the  most  noble  and  honorable  character.  And 
yet  it  would  scarcely  seem  possible  that  a  man 
could  entertain  so  exalted  an  opinion  of  his 
business,  as  to  consider  himself  exempt  from  the 
common  privileges  and  obligations  of  citizenship. 
And  this  remark  would  have  especial  force,  where 
the  existing  government  imposed  individual 
duties  and  responsibilities.  The  very  opposite 
conclusion  would  be  the  more  rational ;  the 
higher  and  more  sacred  the  particular  calling 
and  obligations  of  the  individual,  the  more  grave 


150 


THE   PHYSICIAN   AS   CITIZEN. 


and  important  his  responsibilities  as  a  citizen. 
The  natural  supposition  would  be  that  such  pur- 
suit derived  its  sacredness  from  its  opportuni- 
ties   and    power   of    benefiting   the    race.     For 
surely  that  business  in  life  must  be  of  all  others 
the  most  selfish,  which  so  exalts  the  individual 
above  his  fellows,  that  he  lives  entirely  to  himself. 
There  is,  we  believe,  in  our  profession,  a  wide- 
spread and  growing  misconception  of  the  duties 
of  medical  men  as  citizens ;  and  this  error  of  judg- 
ment is  far  more  prevalent  among  that  class,  the 
members  of  which  are  regarded  as  representatives 
of  the  true  spirit  of  medicine.     With  them,  to  exer- 
cise that  most  sacred  of  all  the  privileges  of  citi- 
zenship, viz.,  the  choice  of  rulers  by  the  ballot,  is  a 
condescension  of  dignity  never  to  be  submitted 
to,  except,  perhaps,  at  the  solicitation  of  a  wealthy 
patron  who  may  have  a  personal  interest  in  the 
result  of  the  canvass.     And  this  act,  in  itself  the 
most  honorable  perhaps  of  their  lives,  but  truly 
dishonorable  from  its  motives,  is  performed  with 
the  shamefacedness  of  premeditated  guilt.     They 
scorn  a  knowledge  of  our  political  history,  and  a 
familiarity  with  current  political  events,  as  mat- 
ters too  vulgar  to  occupy  the  attention  of  minds 
devoted  to  the  sacred  calling  of  physic.     Diseases 
and  their  remedies  are  the  never-varying  themes 
of  their  thoughts  and  conversation.     Health,  and 
preventive  medicine,  and  all  measures  of  public 
interest,  are  discarded  as  without   the  pale  of 
their  "peculiar  pursuits."     All  such  ignoble  sub- 


THE   PHYSICIAN  AS   CITIZEN.  151 

jects  are  consigned,  with  a  contemptuous  sneer,  to 
that  class  of  medical  men  whom  they  term  "  po- 
litical doctors."     Whoever  has   been  interested 
in  those  measures  which  contemplated  such  so- 
cial reforms   as  would  improve  the  health  and 
happiness  of  the  people,  but  required  the  aid  of 
legislation  to  give  them  form  and  force,  and  has 
sought  the  aid  of  medical  men,  has  found  too  fre- 
quent exhibitions  of  this  false  pride  of  profes- 
sional dignity.     He  has  met  with  physicians  from 
whom  he  anticipated  a  cordial  support,  who  have 
signed  petitions  with  a  manner  indicating  that 
they  tacitly  protested  against  such  desecration  of 
their  names  and  influence.     In  the  recent  crisis 
of  our  national  government,  was  heard,  though  in 
subdued  tones,  the   reproachful  terms  of  these 
wiseacres  of  our  profession ;  the  adoption  of  pa- 
triotic resolutions  by  some  of  our  county  societies, 
the  organization  of  medical  bodies  for  the  supply 
of  hospital  and  other  materials  to  the  army,  and 
the  enlistment  of  surgeons  into  the  country's  ser- 
vice, were  regarded  as  acts  unworthy  of  high-bred, 
physicians.     They  have  no  sympathy  or  fellow- 
ship with  those  who  entertain  such  unprofessional 
subjects,  and  engage  in  such  menial  service.     Pa- 
triotism and  treason  are,  to  them,  meaningless 
words  ;    for,  governed  by  the  catholic  spirit  of 
medicine,  they  regard  only  scientific  attainments 
as  the  test  of  membership  in  their  exalted  social 
state.     It  is  not  a  little  singular  that  in  a  free 
government,  where  the  duties  as  well  as  prin- 


152  THE   PHYSICIAN   AS   CITIZEN. 

ciples  of  the  citizen  are  indefinitely  extended ; 
where  practically,  as  well  as  theoretically,  he  is 
the  sovereign,  there  should  be  a  class  of  persons 
who  lightly  esteem  their  civil  obligations.  And 
it  is  still  more  remarkable,  nay  marvelous,  that 
such  a  class  should  be  found  in  a  profession 
which  holds  the  most  intimate  relations  to  those 
influences  through  which  the  most  beneficial  re- 
sults to  society  may  be  secured.  In  European 
countries  medical  men  regard  it  as  a  proud  dis- 
tinction to  be  engaged  in  the  service  of  the  State  ; 
here  it  is  well-nigh  sufficient  cause  for  expulsion 
from  a  medical  society.  Abroad,  the  most  promi- 
nent physicians  labor  for  years  to  attain  courtly 
rank,  or  positions  in  government  service ;  while 
with  us  an  intimation  of  such  a  penchant  is  evi- 
dence that  the  aspirant  for  political  favor  has 
abandoned  all  claims  to  professional  respecta- 
bility, and  is  gravitating  to  the  lowest  rank  and 
level  of  his  profession.  American  medicine  will 
have  but  half  fulfilled  its  mission  when  it  attains 
the  rank  it  seeks  only  as  a  science.  Upon  it 
are  also  laid  the  burden  and  responsibility  of  im- 
portant social  reforms,  which  it  alone  can  accom- 
plish. Preventive  medicine,  or  the  practical 
application  of  the  principles  of  sanitary  science 
to  the  art  of  living,  is  yet  to  engage  the  earnest 
attention  of  medical  men  in  this  country.  But 
whoever  enlists  in  this  great  work,  must  for  the 
time  incur  the  odium  that  many  foolishly  and 
most  unjustly  attach  to  those  public  movements 


THE   PHYSICIAN   AS   CITIZEN.  153 

of  medical  men  necessary  to  the  establishment  of 
proper  organizations.  But  let  them  not  be  dis- 
heartened. Preventive  medicine  will  yet  be  rec- 
ognized, we  believe,  as  the  noblest  branch  of  the 
science,  and  those  who  succeed  in  systematizing 
its  operations  among  our  people,  will  be  regarded 
as  the  most  worthy  of  the  profession,  as  well  as 
public  benefactors.  Says  Dr.  Push :  "  Permit 
me  to  recommend  to  you  a  regard  to  all  the  in- 
terests of  your  country.  It  was  in  Pome,  where 
medicine  was  practised  only  by  slaves,  that  phy- 
sicians were  condemned  by  their  profession 
'  mutam  exercere  artem.'  But  in  modern  times, 
and  in  free  governments,  they  should  disdain  an 
ignoble  silence  upon  public  subjects.  The  Ameri- 
can revolution  has  rescued  physic  from  its  former 
slavish  rank  in  society.  For  the  honor  of  our 
profession  it  should  be  recorded,  that  some  of 
the  most  intelligent  and  useful  characters  both 
in  the  cabinet  and  the  field,  during  the  late  war, 
have  been  physicians."  An  active  participant  in 
most  of  the  political  measures  of  the  Revolution ; 
with  such  colleagues  as  Morgan,  "Warren,  Ship- 
pen,  Jones,  and  Bartlett ;  Push  was  led  to  be- 
lieve that  this  great  event  would  form  an  era 
in  the  social  and  political  history  of  his  profes- 
sion. And  contemplating  the  influences  and 
privileges  which  citizenship  under  a  free  govern- 
ment conferred,  he  foresaw  that  medical  men,  by 
their  intimate  social  relations,  might  and  should 
be  an  important  element  of  political  power. 


XXX. 
MEDICAL    EXPEKTS. 


THE  value  of  medical  evidence  in  questions 
involving  the  causes  and  nature  of  deaths 
by  unknown  means  has  now  been  recognized 
nearly  three  centuries  and  a  half.  During  this 
long  period  it  has  frequently  demonstrated  its 
accuracy  of  investigation  of  the  subtle  forces 
which  destroyed  life,  and  led  with  unerring  cer- 
tainty to  the  detection  of  the  criminal  or  the  ex- 
culpation of  the  innocent.  In  this  field  of 
research  no  other  class  of  scientific  experts  can 
supersede  the  medical  expert.  His  conclusions 
are  based  on  an  accurate  knowledge  of  physi- 
ology, pathology,  anatomy,  chemistry,  and  the 
physical  sciences,  together  with  those  attendant 
circumstances  which  are  open  to  the  observation 
of  every  one.  The  special  knowledge  which  he 
is  supposed  and  admitted  to  have,  gives  him 
the  position  of  a  skilled  person,  or  one  who  is 
capable  of  deciding  questions  beyond  the  com- 
prehension of  ordinary  witnesses.  The  position 
of  the  medical  witness,  therefore,  becomes  one  of 
great  importance  to  the  cause  of  justice  and 
truth,  as  well  as  of  great  responsibility.  The 
courts  of  law  are  accustomed  to  accord  to  his 


MEDICAL  EXPERTS.  155 

testimony  great  value,  and  to  regard  his  opinions 
with  the  most  profound  respect.  To  sustain  well 
the  high  character  of  the  medical  expert  in 
courts  is  not  a  trivial  undertaking.  In  the  first 
place,  no  small  amount  of  knowledge  of  the  med- 
ical sciences  in  general  is  requisite  to  cope  with 
the  abstruse  and  obscure  questions  to  which 
medico-legal  questions  give  rise.  There  was  a 
time  indeed  when  surgeons  only  were  allowed  to 
testify  as  to  the  wounds  of  murdered  persons  in 
English  courts ;  but  that  period  has  passed,  and 
to-day  the  medical  witness  is  expected  to  bring 
to  the  stand  the  most  profound  knowledge  of  his 
profession  in  all  its  departments  of  scientific  in- 
vestigation. In  the  second  place,  he  must  be  an 
acute  and  logical  reasoner  in  order  to  place  the 
facts  which  he  has  drawn  from  science  and  from 
the  surrounding  circumstances  in  such  harmony 
of  relation  as  to  make  an  unbroken  chain  of 
logical  sequences.  We  might  add  as  a  third 
qualification,  and  which  is  the  most  important  of 
all  in  the  interest  of  justice — a  perfectly  disinter- 
ested mind,  devoted  only  to  the  discovery  of  the 
truth.  We  have  frequent  and  painful  proofs 
that  medical  men  do  not  always  appreciate  the 
responsible  and  truly  dignified  position  which 
they  are  called  to  fill  in  courts  of  justice.  For- 
getful that  they  are  presumed  to  be  experts,  or 
persons  whose  scientific  attainments  give  their 
opinions  great  weight,  and  above  all  that  they 
are  unbiased  by   a,ny   circumstance    connected 


156  MEDICAL  EXPERTS. 

with  the  case,  except  positive  and  unquestioned 
facts,  too  frequently  the  medical  witness  takes 
the  stand  an  avowed  partisan,  and  shapes  his 
evidence  to  sustain  some  personal  interest  or 
preconceived  notion.  Nearly  all  the  cases  of 
trials  for  alleged  malpractice  have  their  real 
origin  in  the  malicious  suggestions  of  a  medical 
man,  who  subsequently  comes  upon  the  witness- 
stand  as  an  expert  in  settling  the  many  questions 
in  which  he  has  a  personal  interest.  The  posi- 
tion of  such  a  witness  is  unenviable  in  the  ex- 
treme. He  is  unworthy  the  name  and  association 
which  give  him  such  power  for  evil,  and  should 
be  discountenanced  by  every  means  which  we 
possess  in  our  individual  or  organized  capacity. 
The  injury  which  such  men  inflict  upon  their 
brethren  is  incalculable ;  many  are  made  to  in- 
cur heavy  expenses  ;  others  are  mulcted  in  dam- 
ages, which  afterward  hang  heavily  upon  their 
resources,  while  a  few  are  discouraged  and  driven 
from  the  profession.  It  is  the  duty  of  local 
societies  to  make  stringent  regulations  in  regard 
to  that  class  of  physicians  who  incite  a  prosecu- 
tion for  malpractice.  The  case  should  be  inves- 
tigated rigidly,  and  if  the  evidence  convicts,  the 
name  of  the  guilty  party  should  be  stricken  from 
the  membership  of  every  medical  organization, 
Important  as  is  the  position  of  the  medical  man 
in  courts  of  law,  when  upon  his  opinion  rests 
the  fair  fame  of  a  brother  practitioner,  it  bears 
no  comparison  to  those  cases  in  which  the  life  of 


MEDICAL   EXPERTS.  157 

an  individual  is  trembling  in  the  balance.  The 
responsibility  which  falls  upon  the  medical  wit- 
ness in  trials  for  suspected  murder,  is  more 
weighty  than  that  which  occurs  in  any  other 
relation  of  life.  He  assumes,  indeed,  to  deter- 
mine with  more  accuracy  than  can  any  other 
witness  who  did  not  actually  see  the  deed  com- 
mitted, the  nature  and  causes  of  death.  His 
opinion  is  based  upon  an  analysis  of  facts,  often 
extremely  subtile,  and  generally  susceptible  of 
various  explanations.  How  important  that  his 
mind  should  be  entirely  free  from  all  precon- 
ceived theories,  and  that  he  should  be  uninflu- 
enced by  position  or  prejudice.  And  yet  we 
have  occasional  instances  of  medical  witnesses 
exhibiting  a  degree  of  feeling  altogether  incom- 
patible with  that  dispassionate  search  after  truth, 
which  should  characterize  the  expert.  Phy- 
sicians, also,  occasionally,  seem  forgetful  of,  or 
at  least  disregard  professional  courtesy,  and 
manifest  toward  the  opinions  of  their  brethren 
a  degree  of  contempt  quite  unworthy  of  their 
high  position.  In  the  history  of  a  recent  mur- 
der trial  in  this  State,  we  have  a  melancholy  ex- 
ample of  the  rancor  which  one  medical  witness 
may  exhibit  toward  another,  growing  out  of  a 
mere  difference  of  opinion.  Accusations  of  dis- 
honesty, falsehood,  and  sinister  motives  are  as 
unqualifiedly  made  against  a  member  of  the  pro- 
fession of  irreproachable  character  and  of  the 
highest  respectability,  but  a  differing  witness  in 


158  MEDICAL  EXPERTS. 

the   case,  as  if  the  parties  were  in  a  common 
street-brawl.     One  witness  taunts  another  with 
being  paid  for  his  services,  as  though  that  were 
a  crime,  and  at  the  same  time  announces  that 
he  himself  received  nothing,  as  though  that  were  a 
virtue,and  gave  greater  impartiality  to  his  opinion. 
Every  physician  who  resorts  to  such  unworthy 
and  unprofessional  means  in  a  court  of  law,  only 
degrades  himself.     It   is  desirable  that  in  this 
country  our  profession  should  study  thoroughly 
forensic   medicine.     The   courts   accord   to   our 
opinions  great  weight,  and  it  is  exceedingly  im- 
portant that  we  do  not  abuse  or  lessen   their 
confidence.     And  to  this  end  students  should,  as 
a  body,  study  medical  jurisprudence,  and  become 
familiar  with  their  duties  and  obligations  when 
summoned  to  the  witness-stand.     In  most  of  the 
colleges  this  branch  is  taught  by  a  physician,  and 
in  a  most  superficial  manner.    The  student  learns 
but  little  of  practical  value,  especially  as  regards 
the  nature  of  medical  evidence.     On  this  latter 
subject,  the  one  of  which  he  knows  the  least,  and 
yet  requires  the  most  knowledge,  he  should  be 
taught  by  a  competent  legal  instructor.      This 
defect  in  the  system  of  medical  teaching  is  be- 
coming more  and  more  evident,  and  until  reme- 
died by  the  permanent  establishment  of  chairs  of 
Medical    Jurisprudence,    and    the    selection    of 
qualified  teachers,  the  graduate  must  be  regarded 
as  entirely  deficient  in  an  important  branch  of 
his  education. 


XXXI. 
INCURABLE   DISEASES. 


MEDICAL  men  have  one  stereotyped  com- 
plaint against  the  community.  It  is  the 
want  of  faith  which  the  latter  seem  to  have  in 
the  power  of  medicines  to  cure  diseases.  This 
scepticism  is  thought  by  many  to  be  a  growing 
evil  in  our  times,  and  is  generally  attributed 
to  the  prevalence  of  those  heterodox  systems  of 
practice,  which  eschew  all  drugs  as  poisonous,  at 
least  when  taken  in  tangible  quantities.  The 
physician,  prescribing  under  such  circumstances, 
is  oppressed  with  a  disagreeable  embarrassment, 
which  is  seen  in  his  hesitating  course  and  unde- 
cided treatment.  If  the  patient  or  friends  lacked 
faith  in  his  remedies  before,  they  are  now  con- 
firmed in  their  unbelief,  much  to  his  discredit 
and  discomfort.  He  prescribes  timorously,  and 
often  indiscreetly,  and  in  consequence  fails  to 
prove  by  his  works  that  his  faith  has  a  sub- 
stantial basis.  The  very  prejudice  in  the  popular 
mind  which  he  so  deprecates,  is  strengthened  and 
widened  by  his  own  conduct,  and  rendered  seri- 
ously detrimental  to  his  own  interests,  and  to  the 
position  of  medicine  in  public  favor.  But  is  there 
really  a  want  of  confidence  in  the  public  mind 


160  INCUKABLE   DISEASES. 

in  the  efficacy  of  medicines  ?  We  think  not.  On 
the  contrary,  it  will  more  frequently  be  found,  that 
what  at  first  seemed  incredulity,  is  in  fact  but  an 
overweening  confidence  in  remedies  which  leads 
both  patient  and  friends  to  resort  to  a  larger 
variety  than  the  practitioner  is  disposed  to  em- 
ploy. They  may  thus  lose  confidence  in  the 
physician,  or  in  his  ability  to  select  medicines  for 
the  individual  disease  in  hand,  but  that  there 
must  be  some  drug  all-powerful  to  relieve  the 
malady,  they  do  not  doubt.  A  person  afflicted 
with  an  incurable  disease,  will  seldom  rest  in  the 
belief  that  his  case  does  not  admit  of  cure  by 
medicines.  When  he  has  exhausted  the  resour- 
ces of  one  medical  man,  he  immediately  resorts  to 
another,  and  never  wearies  in  his  search  after 
the  priceless  boon — a  specific  for  his  physical  in- 
firmity. It  is  an  interesting  question  how  far  the 
medical  profession  is  itself  responsible  for  the  prej- 
udice of  the  public  mind.  A  physician  sick  of  an 
incurable  disease,  is  generally  the  most  intract- 
able of  patients.  His  confidence  in  the  power  of 
medicines  to  relieve  him  is  often  morbidly  great. 
He  can  not  brook  disappointment ;  he  will  not 
listen  to  the  suggestion  that  he  is  beyond  reme- 
dial measures.  This  is  but  the  expression  of  that 
habit  of  mind  which  he  has  himself  acquired  in 
endeavoring  to  cure  this  class  of  diseases.  Long- 
experience  of  the  utter  futility  of  his  remedies 
in  such  cases,  has  not  weakened  his  confidence 
in  the   power   of  medicines   to  cure  all  human 


INCUBABLE   DISEASES.  161 

maladies.  The  condition  of  mind  which  the 
physician  exhibits  under  such  trying  circum- 
stances has,  to  a  greater  or  less  extent,  been 
reacting  upon  the  community  in  which  he  lived. 
With  commendable  heroism  he  strives  against 
hope  in  many  a  case,  rather  than  yield  to  all- 
conquering  fate.  He  has  appealed  to  past  expe- 
rience, and  has  ransacked  the  materia  medica, 
but  all  in  vain.  Such  zeal  is  not  lost  on  patient 
and  friends.  Every  new  pill  or  potion  is  hope 
renewed ;  but  disappointment  is  the  inevitable 
result ;  alternating  thus,  the  disease  steadily 
progresses  to  its  inevitable  termination.  The  im- 
pression created  in  the  mind  of  all  is,  that  the  phy- 
sician regards  the  resources  of  his  art  as  quite 
equal  to  every  emergency.  If  they  subsequently 
lose  confidence  in  him,  they  do  not  doubt  the 
power  of  drugs  to  relieve  all  human  ills.  He 
may,  and  doubtless  will,  regard  his  lost  patrons 
as  sceptical  in  regard  to  the  efficacy  of  drugs ;  but 
their  faith  is  really  not  shaken,  except  in  himself. 
Incurable  maladies  furnish  quackery,  in  every 
form  and  grade,  its  chief  source  of  support  and 
profit.  Could  these  affections  be  stricken  from  the 
list  of  human  ills,  or  could  specific  remedies  be 
found  adapted  to  their  prompt  cure,  there  would 
never  be  another  medical  pretender.  Equally 
fatal  to  the  pretensions  of  charlatanism  would 
be  a  profound  and  unalterable  conviction  in  the 
popular  mind  of  the  absolute  incurability  of  cer- 
tain diseases.     The  attempt  to   create   such   a 


162  INCUEABLE  DISEASES. 

belief  will  be  deemed  utopian.  But  may  we  not 
rationally  conclude,  that  the  same  course  of  in- 
struction, which  has  established  the  present  uni- 
versal belief  in  the  efficacy  of  medicines,  could, 
rightly  directed,  not  only  remove  this  ill- 
grounded  faith,  but  in  its  stead  implant  in  the 
mind  of  at  least  every  rational  person  a  firm 
conviction  of  the  incurability  of  many  diseases  ? 
The  statement  is  susceptible  of  demonstration 
so  far  as  regards  many  families,  and  even  com- 
munities, which  have  been  fully  under  the  influ- 
ence of  a  candid  and  earnest  physician.  If  we 
should  fail  in  such  an  undertaking,  we  do  no 
more  than  our  duty  in  ceasing  to  attempt  impos- 
sibilities, and  confining  our  labors  to  the  prac- 
ticable. We  do  not  mean  to  discourage  rational 
efforts  to  discover  remedies  curative  of  diseases 
now  considered  incurable.  All  such  inquiries 
are  praisworthy  and  commendable.  But  we 
would  discourage  that  routine  practice,  so  preva- 
lent, of  repeating  the  trial  of  vaunted  specifics 
in  diseases  thus  far  justly  reputed  irremediable. 
We  degrade  rather  than  advance  the  science  of 
therapeutics  by  such  practice.  It  is  an  im- 
portant question,  then,  how  far  we  ought  to  give 
hope  by  promises  of  new  remedies  in  incura- 
ble diseases.  An  eminent  writer,  Dr.  Latham, 
says : 

''  But  let  us  concern  ourselves  only  with  actual  diseases, 
diseases  existing  and  in  progress.  And  of  these  let  us  ask 
whether  the  fact  that  they  are,  or  are  deemed  to  be,  incura- 


INCURABLE  DISEASES.  163 

ble  or  intractable — the  fact  that  there  is  no  medicine  or 
method  of  treatment  known  by  which  they  have  ever  been 
successfully  managed — whether  this  fact  be  enough  to  war- 
rant physicians  in  doing  and  trying  anything  or  every- 
thing indiscriminately  upon  them? — enough  to  justify  or 
excuse  us  in  falling  in  altogether  with  the  world's  notions, 
and  adopting  the  world's  practice  of  medicine,  as  far  as 
they  are  concerned  ?  I  think  not ;  for  this  would  be  mere 
gambling  with  drugs,  and  not  the  practice  of  medicine." 

Sir  William  Gull  lias  recently  taken  similar 
ground  in  regard  to  the  treatment  of  many  forms 
of  hereditary  diseases,  contending  that  physicians 
should  recognize  the  fact  that  these  alleged  dis- 
eases are  but  normal  conditions  of  the  tissues 
which  -will  not  yield  to  treatment.     He  says  : 

"  Many  states  are  still  considered  and  treated  as  diseases 
which  are  certainly  not  diseases  at  all.  Thus  it  may  be 
fairly  said  there  are  some  people  who  are  made  to  ail,  and 
without  having  disease,  are  born  to  suffer.  Under  the 
present  condition  of  things  they  can  not  maintain  a  com- 
fortable equilibrium.  They  are  always  ailing.  Medicine 
fails  on  such.  Unstable  health  is  their  law,  in  spite  of  the 
pharmacopoeia.  In  practical  medicine  it  is  important  to 
recognize  this.  .  .  .  Yet  I  may  appeal  to  my  hearers 
if  they  can  not  recall  cases  where  they  have  prescribed  all 
the  farrago  of  so-called  tonics,  with  as  good  a  purpose  as 
if  they  would  thereby  strive  to  prevent  the  setting  of  the 
sun." 

It  is  not  contended  that  the  services  of  a  phy- 
sician should  cease  when  a  disease  is  proved  to 
be  incurable.  All  such  diseases  may  be  palli- 
ated, and  the  progress  of  many  may  be  mate- 
rially arrested  by  proper  treatment. 


XXXII. 
MOKTALITY    IN    HOSPITALS. 


IN  the  first  lines  of  the  preface  to  her  ad- 
mirable work,  Notes  on  Hospitals,  Miss 
Nightingale  remarks  :  "  It  may  seem  a  strange 
principle  to  enunciate  as  the  very  first  require- 
ment in  an  hospital  that  it  should  do  the  sick  no 
harm."  It  does  indeed  seem  strange  that,  in 
this  day  of  the  universal  recognition  of  the  neces- 
sity of  hospitals,  one  of  the  ablest  writers  on  this 
subject  should  lay  down  as  the  first  principle  in 
their  construction  that  they  do  the  sick  no  harm. 
We  have  been  accustomed  to  regard  the  hospi- 
tal as  an  asylum  where  every  arrangement  and 
appliance  necessarily  tended  to  restore  the  sick 
to  health.  To  the  temples  of  the  ancients  flocked 
the  sick,  the  lame,  the  blind,  as  to  shrines  of 
health,  to  be  healed  of  their  infirmities.  Out  of 
this  custom  grew  the  modern  hospital.  Is  it 
really  true  that,  after  centuries  of  experience,  we 
have  so  far  departed  from  the  original  idea  in  the 
establishment  of  hospitals  that  we  need  to  be  ad- 
monished of  the  real  object  of  such  institutions? 
Must  we  learn  anew  that  hospitals  are  designed 
for  the  cure  of  the  sick  ?  Whoever  calmly  views 
this   subject   in   the   light   of  experience,   must 


MOETALITY^IN   HOSPITALS.  165 

acknowledge  that  Miss  Nightingale  has  stated  a 
truth  full  of  significance   and  deserving  of  the 
most  serious  consideration.     It  is  too  true,  as  she 
remarks,  "  that  the  actual  mortality  in  hospitals, 
especially  in  those  of  large  crowded  cities,  is  very 
much  higher  than  any  calculation  founded  on  the 
mortality  of  the  same  class  of  diseases  among 
patients  treated  out  of  hospitals  would  lead  us  to 
expect."     This  is  especially  the  case  with  those 
diseases    classified   under  the   general  head   of 
typhoid,  as  erysipelas,  pyaemia,  continued  fevers, 
etc.     Our  large   metropolitan   hospitals   always 
show  an  excessive   death-rate   from   these   dis- 
eases.    But  there  is  a  still  more  significant  sense 
in  which  hospitals  may  be  allowed  to  prove  harm- 
ful to  the  sick,  viz.,  by  exposing  them  to  local 
causes  of  diseases,  which  should  never  exist  in  a 
hospital.     It  now  not  unfrequently  happens  that 
patients  enter  general  hospitals  with  simple  dis- 
eases, but  contract  other  maladies  of  a  more  fatal 
character,  of  which  they  die.     The  aggregate  mor- 
tality of  this  class  from  fever  and  typhoid  diseases 
in  large  city  hospitals  is  not  inconsiderable.     In 
every  lying-in  ward  or  hospital  we  find  striking 
proofs  of  the  truth  of  this  statement.     Every  life 
sacrificed  from  such  causes  is  needlessly  wasted. 
The  practical  direction  which  we  wish  to  give  to 
these  facts  is  upon  those  who  are  interested  in 
the    establishment    of    new  hospitals.     Let   us 
briefly  glance  at  some  of  the  causes  of  excessive 
hospital  mortality.     First,  and  chiefly,  is  an  in- 


166  MORTALITY   IN   HOSPITALS. 

salubrious  location.  A  permanent  general  hos- 
pital should  never  be  located  in  thickly  settled 
parts  of  the  town.  The  death-vapor  which  over- 
hangs the  crowded  quarters  of  a  large  town 
affects  most  disastrously  the  sick  congregated  in 
hospital  wards.  This  fact  is  strikingly  shown 
in  the  vast  difference  of  mortality  between  city 
and  country  hospitals.  In  England  the  rate  of 
mortality  in  the  country  hospitals  is  considerably 
less  than  half  that  of  the  London  hospitals. 
Secondly,  hospitals  should  be  so  constructed  as 
to  give  a  large  amount  of  air-space  to  each  pa- 
tient, with  the  rapid  and  constant  renewal  of  air 
by  night  and  day.  No  hospital  is  a  proper  resi- 
dence of  the  sick  which  does  not  afford  him  a  full 
and  constant  supply  of  fresh  and  pure  air.  We 
have  not  yet  reached  the  ultimatum  of  thorough 
ventilation.  By  the  means  now  employed,  the 
air  in  the  centre  of  a  ward  is  stirred,  but  we  fail 
to  flush  the  floors  and  sweep  the  close  corners 
with  renewed  currents.  Thirdly,  over-crowding 
is  an  evil  closely  allied  to  deficient  ventilation. 
The  statistics  of  hospitals  show  an  exact  corre- 
spondence of  the  rate  of  mortality  with  the  num- 
ber of  patients  in  a  single  building.  In  a  hos- 
pital with  100  inmates  the  chances  of  recovery 
from  a  given  severe  disease  are  one-third  greater 
than  in  a  hospital  with  300  inmates.  We  see 
this  fact  strikingly  illustrated  in  the  difference  in 
mortality  between  city  and  village  hospitals. 
The  former  usually  have  300  inmates,  the  latter 


MORTALITY   IN   HOSPITALS.  167 

rarely  more  tlian  twenty-five  ;  while  the  mortality 
of  the  former  is  marked  at  100  per  cent,  the  lat- 
ter is  rated  at  less  than  fifty.  Finally,  the  ad- 
mission of  contagious  and  infectious  diseases  to 
general  hospitals  imperils  the  lives  of  the  inmates. 
The  most  dangerous  of  these  diseases  which  still 
finds  admission  to  the  wards  of  many  general 
hospitals,  is  typhus.  The  mortality  records  of 
one  of  the  largest  hospitals  in  this  country  affords 
a  melancholy  illustration  of  the  truth  of  this  state- 
ment. During  a  period  of  but  nine  months,  fif- 
teen of  the  resident  medical  staff  were  attacked 
with  this  fever,  contracted  within  its  walls,  of 
whom  five  died.  This  is  a  startling  record  of 
mortality  under  any  circumstances,  but  in  the 
present  instance  is  simply  harrowing.  Five 
young  physicians,  in  the  vigor  of  early  man- 
hood, lingering  still  in  this  great  practical  school 
to  give  to  their  education  that  perfection  of  tem- 
per and  firmness  necessary  to  rapid  success,  fall 
victims  to  fever.  In  the  death  of  such  young 
men,  highly  educated,  devoted  to  duty,  and  with 
noble  aspirations  for  excellence,  the  whole  pro- 
fession sustains  a  great,  an  irreparable  loss.  It 
-can  ill  afford  to  needlessly  expose  to  inevitably 
fatal  diseases  those  who  are  so  eminently  quali- 
fied to  sustain  its  dignity  and  honor,  and  to  ad- 
vance the  science  of  medicine  beyond  its  present 
bounds.  If  these  things  must  needs  be,  if  suffer- 
ing humanity  demands  the  sacrifice,  the  victims 
are  always  ready  to  be   offered.     The   noblest 


168  MORTALITY   IN   HOSPITALS. 

members  of  our  profession  have  yielded  their 
lives  a  willing  offering  to  stay  or  mitigate  the 
horrors  of  pestilential  and  epidemic  diseases. 
Our  hospitals  bear  ample  testimony  to  the 
courage  and  heroic  bravery  of  young  medical 
men  in  the  midst  of  danger  from  the  most  fatal 
infectious  and  contagious  diseases.  No  post  of 
duty  is  deserted,  and  when  one  falls  another  in- 
stantly steps  forward  to  fill  the  ranks.  But  how- 
ever important  it  may  often  be  for  the  physician 
to  take  his  life  in  his  hand  and  go  boldly  into  the 
midst  of  infection,  and  fearlessly  incur  the  threat- 
ened penalty,  the  question  recurs  :  Is  it  neces- 
sary to  sacrifice  so  many  valuable  lives  of  young 
medical  men  in  our  hospitals  to  typhus  or 
typhoid  fever  ?  Are  not  these  preventable  dis- 
eases? The  spacious  and  liberally  provi- 
sioned buildings,  with  their  thousands  of  com- 
fortable beds,  bear  testimony  to  the  beneficent 
and  large  purposes  of  the  governing  boards  of 
these  noble  institutions.  But  if  it  occurs  that  by 
some  failure  to  conform  their  administration  in 
accordance  with  the  inflexible  laws  of  sanitary 
science  and  the  requirements  of  nature,  the  costly 
edifices  and  the  richly  furnished  wards  are  trans- 
formed into  fever-nests,  and  furnaces  of  infec- 
tious and  deadly  disease,  spreading  death  to  all 
classes  of  patients,  and  secretly  poisoning  the 
faithful  attendants  and  zealous  young  physicians 
who  are  on  duty  there,  then  we  are  in  duty  bound 
to  press  the  inquiry — Who  is  responsible  for  the 


MORTALITY  IN  HOSPITALS.  169 

needless  sacrifice  of  these  lives  ?  and  the  official 
guardians  of  those  institutions  must  ask,  What 
does  sanitary  science  teach  concerning  such 
maladies  ?  Though  the  localization  of  these  dis- 
eases is  an  opprobrium  to  any  hospital,  lamenta- 
ble experience  in  a  very  large  number  of  hos- 
pitals in  our  country  has  shown  how  very  difficult 
is  the  task  of  eradicating  these  poisons  from  the 
wards.  Sanitary  science  teaches,  and  experi- 
ence has  abundantly  demonstrated,  that  typhus 
and  typhoid  fevers  are  absolutely  preventa- 
ble. But  the  virus  of  these  fevers  must  be 
rigorously  dealt  with  as  a  terrible  foe.  Its 
birth  is  in  the  crowded  ward,  the  unventilated 
and  densely  packed  hall,  the  filthy  tenement,  and 
where  effete  organic  matter  chances  to  be  ac- 
cumulated or  neglected.  The  essential  fact  re- 
lating to  the  processes  of  these  fevers  is,  that 
they  rapidly  waste  the  organic  elements  of  the 
human  structure,  and  that  in  ordinary  apart- 
ments, with  an  atmosphere  at  all  confined,  as  by 
closure  of  windows  and  open  fire-places,  the 
typhic  poison  is  fearfully  communicable  or  per- 
sonally infectious  and  contagious.  And  these 
facts  demand  attention  from  the  governing 
boards  of  hospitals.  The  same  fever  tragedy 
is  enacted  within  the  same  walls,  and  from  the 
same  preventable  causes,  year  after  year ;  and  it 
will  be  repeated  every  winter  until  those  causes 
are  removed.  Five  of  the  choicest  young  phy- 
sicians  in    a    single   institution   killed   by   this 


170  MORTALITY   IN   HOSPITALS. 

stealthy  enemy  of  our  hospitals  during  the  past 
few  months!     More  such  sacrifices  will  rapidly 
follow,  unless  medical  men  come  forward,  and, 
with  the  redeeming  power  of  sanitary  knowledge, 
effect  the  needed  reform.     As  a  preliminary  step 
in  reform,  let  a  rule  be  rigidly  and  peremptorily 
enforced,  that  patients  with  typhus  or  typhoid 
fever  shall  not  be  allowed   to  remain  in  a  ward 
where  there  are  any  other  maladies,  surgical  or 
medical ;    and,   secondly,  let  there  be  such  im- 
provements in  the  ventilation  of  all  the  wards  and 
hospital  apartments  as  will  effectually  prevent  the 
presence  or  the  continuance  of  an  endemic  typhic 
condition.     But   such   reforms    are   exceedingly 
difficult  of  execution,  especially  in  general  hos- 
pitals ;  the  windows  will  be  closed,  the  fire-places 
are  already  hermetically  sealed  in   most  wards, 
and,  sad  to  say,  nurses  and  patients  alike  cry  out 
against  fresh  air ;  they  are  not  accustomed  to  such 
air;    surgical    cases,   consumptives,    dyspeptics, 
and  bed-ridden  patients  with  organic  maladies, 
will   resist   all    ventilation.     For   such,  and  for 
stronger  reasons,  the  fever  patients  must  be  put 
into  a  domestic  quarantine,  and  should  be  ker>t 
immersed  in  fresh  air  and  sunlight.  And  for  fever 
wards  there  should  be  a  specially  rigid  govern- 
ment, and  specially  trained  nurses.     This  can  only 
be    thoroughly    accomplished     by    establishing 
fever  hospitals.     And  we  put  the  question  to  the 
governing  boards  :  Ought  you  not  to  open  build- 
ings for  the  reception  and  treatment  of  fever? 


MORTALITY  IN   HOSPITALS.  171 

A  simple  pavilion  can  be  quickly  constructed 
with  full  ventilation,  which  would  insure  a  greater 
percentage  of  cures,  and  complete  immunity  of 
attendants  from  this  fatal  disease.  Such  a  fever 
pest-house  is  as  much  required  as  a  separate 
building  for  the  isolation  of  small-pox.  We  know 
how  vague  and  uncertain  the  practical  knowledge 
of  these  considerations  is  among  laymen ;  and 
because  we  are  forced  to  witness  most  cruel 
and  needless  sacrifices  of  precious  lives,  in  con- 
sequence of  such  inattention  to  momentous  facts3 
we  speak  thus  urgently.  And  we  pray  our  medi- 
cal brethren  to  lend  their  aid  to  the  work  of 
rooting  out  the  fever  nests  of  our  crowded  dis- 
tricts. Let  them  insist  upon  the  removal  and 
proper  surveillance  of  all  communicable  sources 
of  contagious  fever,  and  soon  we  shall  see  each 
hospital  establishing  a  separate  and  well-isolated 
pavilion  for  the  treatment  of  such  fever.  It 
is  demonstrable  that  not  until  such  isolation  is 
adequately  provided,  will  fevers  cease  to  burst 
forth  in  our  large  hospitals  ;  and  while  the  fever 
demon  of  the  crowded  wards  holds  carnival, 
noble  young  martyrs  will  swell  the  immortal 
-group  of  faithful  physicians  whose  heroism  in 
duty  ennobles  the  history  of  the  medical  art,  and 
to  whose  names  the  profession  affectionately 
points,  while  it  proudly  inscribes  upon  the  tablet 
sacred  to  their  memory  : 

ILEC  MEA  ORNAMENTA  SUNT. 


XXXIII. 
DISEASES    OF    CONSCEIPTS. 


THE  medical  examination  of  conscripts  during 
war  presents  a  novel  duty  to  the  profession. 
While  the  volunteer  desires  to  enter  the  service, 
and  consequently  conceals  or  makes  light  of  his 
disabilities,  the  conscript  wishes  to  escape  ser- 
vice, and  to  do  so,  feigns  disease  or  occasionally 
maims  himself.  The  latter  examination  is  much 
more  difficult  than  the  former,  involving  often 
the  nicest  discrimination  of  appearances,  and  the 
most  careful  study  of  symptoms  made  conspicu- 
ous but  without  an  adequate  cause.  All  the  most 
recent  methods  of  investigation  must  be  applied, 
and  oftentimes  with  much  more  skill  than  in 
ordinary  examinations.  The  feigning  of  disease 
by  conscrij)ts  has  long  been  practiced,  and  most 
governments  have  passed  stringent  laws  relating 
to  it.  Charondas,  among  the  Greeks,  punished 
those  who  employed  stratagem  to  avoid  going  to 
war,  by  exposure  in  the  dress  of  women  on  a 
scaffold  for  three  days.  In  the  Roman  State 
conscripts  often  maimed  themselves.  Some  cut 
off  their  thumbs  (pollice  trunci,  poltroons),  as  was 
witnessed  in  the  war  of  the  rebellion.  But  they 
were  still  compelled  to   serve.     Theodosius  or- 


DISEASES   OF  CONSCRIPTS.  173 

dained  that  two  maimed  conscripts  furnished  by 
a  district  should  count  only  as  one  efficient  re- 
cruit in  the  prescribed  levy.  Constantine  ordered 
that  persons  self-mutilated  should  be  branded 
and  still  retained  in  service.  Other  emperors 
punished  persons  who  maimed  themselves  to 
avoid  serving  in  the  campaigns  of  the  Republic 
still  more  severely,  and  Augustus  even  put  some 
to  death.  In  modern  times,  persons  endeavoring 
to  escape  service  by  feigning  disease  or  disabling 
themselves,  have  been  sentenced  to  imprison- 
ment, to  receive  corporeal  punishment,  or  have 
been  compelled  to  serve  in  the  army  for  life.  To 
determine  the  nature  of  the  complaint  of  the  con- 
script, whether  true  or  feigned,  it  early  became 
necessary  to  call  in  the  services  of  physicians. 
And  it  is  not  very  creditable  to  our  profession  to 
find  in  subsequent  legislation  evidences  of  the 
connivance  of  the  examining  surgeon  with  the  re- 
cruit to  effect  the  exemption  of  the  latter.  In 
the  Code  de  la  Conscription  is  a  regulation  to  this 
effect :  "  Officers  of  health  and  others,  convicted 
of  having  given  a  false  certificate  of  infirmities  or 
disabilities,  or  of  having  received  presents  or 
'  gratifications,  were  to  be  punished  by  not  less 
than  one  or  more  than  two  years'  imprisonment, 
or  by  a  fine  of  not  less  than  300  or  more  than 
1,000  francs."  In  1818  it  was  ordered  by  the 
French  Government  that  medical  officers  who 
were  proved  to  be  accomplices  of  persons  en- 
deavoring to  escape  service  when  called  upon, 


174  DISEASES   OF   CONSCRIPTS. 

should  be  imprisoned  from  two  months  to  two 
years,  besides  being  fined  200  to  2,000  francs. 
Still  later,  the  surgeon  who  gave  false  certificates 
for  liberation  or  exemption  from  the  public  ser- 
vice, should  be  punished  with  from  two  to  five 
years'  imprisonment,  and  if  he  accepted  bribes 
and  promises  the  penalty  was  banishment. 
Other  governments  have  found  it  necessary — and 
we  acknowledge  the  fact  with  shame — to  intro- 
duce a  clause  punishing  more  or  less  severely  the 
delinquent  medical  examiner  of  conscripts.  The 
severe  European  wars  of  the  early  part  of  this 
century,  and  the  frequent  conscriptions  that  were 
made,  added  so  many  to  the  exempts  from  disa- 
bility that  the  fact  arrested  public  attention. 
More  thorough  investigation  was  made  into  the 
character  of  the  diseases  of  those  claiming  ex- 
emption, when  it  was  found  that  vast  numbers 
were  simulated  or  self-inflicted.  This  led  to  a 
more  systematic  study  of  feigned  diseases,  and 
the  subject  became  one  of  great  public  impor- 
tance, for  upon  it  often  depended  the  integrity  of 
the  army.  During  the  last  quarter  of  a  century 
great  advances  have  been  made  in  establishing 
upon  correct  principles  the  proper  interpretation 
of  feigned  diseases.  This  is  seen  in  the  compari- 
son of  the  French  conscription  with  recent  in- 
vestigations. From  1800  to  1810  every  available 
man  was  pressed  into  the  service  of  the  French 
army,  and  yet,  in  every  one  thousand  rejections, 
there  were  found,   idiots,   8 ;    deaf,   17 ;    short- 


DISEASES   OF   CONSCRIPTS.  175 

sighted,  58  ;  stammerers,  9  ;  epileptics,  21 ;  dis- 
eased eyes,  121 ;  pulmonary  affections,  169. 
Eecent  examinations  show  for  one  thousand 
rejections :  idiots,  5  ;  deaf,  2  ;  stammerers,  3  ; 
epilepsy,  1 ;  diseased  eyes,  63  ;  pulmonary  affec- 
tions, 7.  It  is  proper  to  infer  that  the  balance 
in  conscription  were  feigned  diseases  or  defects 
which  the  examiner  could  not  detect.  The  dis- 
eases which  conscripts  feign  are  found  to  em- 
brace the  whole  category  of  human  ailments. 
Ludicrous  as  was  the  scene  at  the  bar  of  Jupiter 
when  all  the  sick  and  maimed  of  the  earth  came 
forward  to  exchange  diseases,  it  is  surpassed  by 
the  concourse  of  disabled  which  throng  the  ex- 
aminer's office.  Hundreds  who  have  always 
been  regarded  by  their  intimate  friends  as  sound 
in  "  wind  and  limb"  are  now  found  to  be  hope- 
less asthmatics  or  confirmed  cripples.  Many  a 
gay  and  festive  young  bachelor  has  suddenly 
passed  to  the  shady  side  of  forty-five.  Many 
heads  have  become  gray  from  the  neglect  of  the 
coloring  hair  tonic,  and  many  artificial  eyes  have 
fallen  from  their  sockets,  leaving  sad  evidences 
of  the  insidious  workings  of  age  and  disease,  and 
revealing  the  mysterious  arts  of  fashion  and  the 
skillful  manner  by  which  it  conceals  age  and  in- 
firmities. Every  physician  must  have  noticed 
during  a  draft  to  fill  the  ranks  of  the  army,  an 
increase  among  his  male  patients  of  hernia, 
varicocele,  varices,  distressing  coughs,  and  evi- 
dences of  hereditary  insanity,  epileps}r,  apoplexy, 


176  DISEASES   OF   CONSCEIPTS. 

etc.  To  discriminate  between  the  false  and  true 
will  require  great  experience,  care,  and  skill  in 
the  diagnosis  of  disease.  While  it  is  of  the 
greatest  importance  to  detect  the  impostor  and 
hold  him  to  strict  accountability,  it  is  not  the  less 
important  to  the  public  service,  and  but  common 
justice  to  the  individual,  that  the  genuinely  dis- 
abled should  be  exempt.  If  the  latter  is  pressed 
into  the  army,  he  becomes  at  once  an  incum- 
brance. He  may  endure  the  slight  fatigue  of  the 
camp,  and  become  a  well-drilled  soldier,  but  the 
first  exposure  or  fatiguing  march  sends  him  to 
the  hospital,  an  invalid  for  the  remainder  of  his 
term  of  enlistment.  The  medical  examination  of 
persons  claiming  exemption  from  service,  and 
alleging  disability,  must,  therefore,  always  be  a  re- 
sponsible duty.  A  distinguished  medical  au- 
thor has  very  justly  remarked  :  "  It  is  obvious 
that  the  more  we  know  of  disease  by  reading  and 
observation,  the  more  patience  and  temper  we 
possess,  the  more  successful  shall  we  be  in 
the  detection  of  imposture."  Again,  the  chief  of 
the  army  medical  department  of  the  Prussian 
army  states,  "  that  a  knowledge  and  experience 
greater  than  is  generally  believed,  along  with  an 
acquaintance  with  anatomy,  physiology,  and  pa- 
thology, is  especially  required  to  decide  upon 
the  health  and  general  efficiency  of  recruits,  and 
to  distinguish  between  defects  that  may  be  real 
from  those  that  are  only  feigned." 


XXXIV. 
PEESCEIPTION    WETTING. 


THE  recent  case  of  death  in  consequence  of 
a  mistake  in  compounding  a  prescription, 
reveals  one  of  those  careless  habits  of  physicians 
which  demand  reform.     It  is  probable  that  the 
prescription,  in  this  instance,  was  as  legible  as 
the  penmanship  of  physicians  ordinarily  is,  and 
that  the  druggist  was  the  censurable  party  in  the 
main ;  but  the  fact  that,  in  the  present  mode  of 
prescribing,  mistakes  similar  to  this  not  unfre- 
quently  occur,   sometimes   producing  the   most 
melancholy  consequences,  should  lead  the  pro- 
fession to  inquire  whether  there  is  not  some  rem- 
edy or  some  safeguard  against  this  evil.     Only  a 
few  years  ago,  at  one  of  the  best  known  and  best 
patronized  drug-stores  in   Broadway,  the   clerk 
"put  up"  antim.  tart,  in  place  of  antim.  pulv., 
and  as  a  consequence  an  interesting  child  with 
scarlet  fever  was  vomited  to  death.     At  another 
store,   powders   containing    poisonous   doses   of 
opium  were  dispensed,  and  the  druggist,  culpably 
remiss,  gave  no  warning,  so  that  the  victim,  an 
infant,  was  narcotized  beyond  recovery.     Again, 
a  liniment  containing  the  most  poisonous  ingre- 
dients was  administered  to  a  child,  through  the 
8* 


178  PRESCRIPTION  WRITING. 

fault  of  a  physician  or  druggist,  or  both,  and  im- 
mediate death  was  the  result.  These  cases, 
among  others,  have  been  made  public,  and 
almost  every  physician  in  general  practice  is 
aware  of  instances  which  have  fallen  under  his 
own  observation,  but  which  few  knew  beyond  the 
circle  of  those  immediately  interested,  in  which 
the  lives  of  patients  were  hazarded,  even  if  they 
were  not  lost,  by  similar  mistakes.  Aside  from 
the  danger  which  attends  the  administration  of  a 
wrongly  prepared  medicine,  the  effect  of  such 
mistakes  is  very  bad,  particularly  as  regards  pub- 
lic opinion.  Probably  the  proportion  of  these 
mistakes  to  the  number  of  prescriptions  dis- 
pensed is  not  greater  than  one  to  five  hundred, 
yet  in  consequence  of  the  publicity  given  to  some 
of  them,  a  widespread  fear,  a  distrust  of  the 
present  system  of  dispensing,  pervades  all  classes 
of  the  community.  How  often  does  the  phy- 
sician find  that  the  medicine  which  he  ordered 
the  day  before  has  not  been  given,  or  has  been 
given  in  reduced  doses  and  at  long  intervals, 
through  the  fear  that  it  was  improperly  prepared, 
and  this,  too,  when  it  is  very  important,  in  order 
to  arrest  or  control  the  disease,  that  the  remedy 
should  be  given  regularly?  How  often,  too, 
do  we  hear  the  wish  expressed,  through  fear  of 
these  mistakes,  that  physicians  would  carry  med- 
icines with  them,  as  is  done  in  the  country,  or  in 
smaller  cities,  or  as  was  customary  in  cities  of 
olden   times?     No   doubt,   the   dread   of   being 


PRESCRIPTION  WRITING.  179 

poisoned  or  injured  by  incorrectly  prepared  med- 
icines operates  as  an  inducement  to  the  employ- 
ment of  irregular  practitioners,  who  provide 
their  own  remedies ;  and  yet,  with  proper  care 
on  the  part  of  physician  and  druggist,  and  a 
proper  relation  between  the  two,  the  system  of 
written  prescriptions  is  as  safe  as  any ;  since 
although  there  are  two  to  make  mistakes,  there 
are  also  two  to  detect  them.  We  purpose  to 
mention  some  particulars,  by  attention  to  which 
on  the  part  of  physicians  the  number  of  deplor- 
able cases  of  fatal  errors  will  be  materially 
diminished.  And  first,  and  most  importantly,  we 
would  call  attention  to  the  miserable  specimens 
of  medical  penmanship  which  can  be  seen  at 
any  of  our  retail  drug-stores.  Druggists  are 
often  puzzled  with  prescriptions  coming  from 
men  eminent  in  the  profession,  in  which  the 
writing  resembles  Egyptian  hieroglyphics  or  the 
queer  marks  of  a  phonographer  rather  than 
that  of  educated  men.  For  such  penmanship 
there  can  be  no  excuse.  There  is  a  second  par- 
ticular in  which  physicians  are  even  more  repre- 
hensible, for  it  is  the  result  of  gross  carelessness. 
We  refer  to  the  careless  practice  of  those  who 
rarely  write  the  directions  on  prescriptions,  or 
even  the  doses.  The  directions  are  given  to  the 
friends  at  home,  who  in  their  grief  or  excitement 
frequently  forget  what  is  said,  and  as  the  drug- 
gist can  not  enlighten  them,  the  medicines  are 
liable  to  be  improperly  administered.     It   is   so 


180  PRESCRIPTION  WRITING. 

easy  a  matter  to  write  full  directions  on  prescrip- 
tions, and  thereby  prevent  much  mischief,  that 
any  practitioner  is  censurable  who  neglects  to  do 
so.     There  is  the  greatest  liability  to  mistake  in 
the   administration  of  medicines  in  those  cases 
where  several  are  sick  in  a  family  at  the  same 
time,  as  often  occurs  when  contagious  diseases 
are  prevalent.     The  medicine  designed  for  one 
may  be   given   to  another.     The  German  phy- 
sicians avoid  this  risk  by  writing  the  name  of  the 
patient  on  the  prescription,  which  is  transferred 
to  the  label  on  the  bottle.     It  would  be  well  if 
all  practitioners  would  do  the  same.     The  phy- 
sician can  not  justify  himself  by  saying,  that  if 
such  mistakes  are  made  it  is  not  his  fault,  but 
the  fault  of  the  family.     It  is  his  duty  to  remove, 
as   far   as    possible,   the    liability  to    mistakes, 
whether  on  the  part  of  the  druggist  or  the  Mends 
of  the  patient.     Let  him  not  only  write  plainly, 
but  if  necessary  use  the  vulgar  terms  rather  than 
the  classic,  if  thereby  he  can  avoid  the  danger 
of  error.     Finally,  prescriptions  should  be  writ- 
ten upon  white  paper  of  ample  size.     Too  fre- 
quently the  practitioner  makes  no  preparation 
when  he  begins  his  daily  calls,  and  seizes  upon 
any  scrap  of   paper  to  write  his  prescription. 
Sometimes  he  finds  a  bit  of  paper  partly  written 
over ;  again,  he  takes  the  fly-leaf  of  a  book ;  or, 
finally,  as  a  last  resort,  the  margin  of  a  news- 
paper.    No  prescription  written  under  such  cir- 
cumstances is  positively  safe. 


XXXV. 
DISEASED    MEATS. 


AMONG  the  subjects  relating  to  the  public 
health  which  should  interest  every  citizen, 
that  of  the  sale  of  diseased  meats  is  of  prime 
importance,  and  merits  especial  attention.  We 
read  the  weekly  reports  of  the  health  authorities 
and  of  the  police,  of  the  amount  of  diseased 
meat  which  they  seize  and  remove,  and  though 
astonished  at  the  enormous  aggregate,  are  ac- 
customed to  believe  that  the  whole  has  been 
removed  from  the  market.  But  such  is  not  the 
case.  We  should  come  nearer  the  truth  did  we 
estimate  the  amount  removed  as  the  hundreth, 
and  perhaps  thousandth,  part  which  finds  its  way 
to  the  tables  of  the  laboring  classes,  who  are 
compelled  to  buy  the  cheaper  class  of  meats. 
Since  the  introduction  of  railroads,  the  increase 
of  diseased  stock  in  our  markets  has  been  very 
marked.  Not  only  does  easy  transportation 
facilitate  the  conveyance  of  diseased  animals, 
which  would  otherwise  be  allowed  to  die  in  the 
country,  but  many  healthy  animals  are  so 
bruised  in  transit  that,  when  slaughtered,  large 
subcutaneous  abscesses  are  disclosed.  For- 
merly stock  reached  the  markets  of  large  cities 


182  DISEASED   MEATS. 

only  by  the  slow  process  of  foot-traveling,  but 
this  necessitated  the  feeding  of  animals  at  proper 
intervals,  in  order  that  they  might  retain  their 
flesh.  They  thus  reached  their  destination  by 
easy  marches,  foot-sore  perhaps,  but  never 
reduced  in  flesh,  nor  weak  from  suppurating 
sores.  In  railway  transportation  the  whole  sys- 
tem is  changed.  The  stock  is  crowded  into  open 
cars,  often  hundreds  of  miles  distant,  exposed  to 
the  weather,  unable  to  lie  down,  jammed  -with 
violence  against  the  sides  of  the  cars  by  the  mo- 
tion of  the  train  or  the  crowding  of  others  ;  and 
to  add  to  this  cruelty,  deprived  of  food  and  water 
until  they  are  slaughtered.  Observation  con- 
firms our  conclusions,  that  few,  very  few,  per- 
fectly healthy  animals  are  now  slaughtered  in 
our  large  cities  ;  but  as  yet  no  sufficient  inquiry 
has  been  made  to  determine  the  extent  of  this 
evil.  In  England,  where  due  importance  is  at- 
tached to  every  cause  or  measure  affecting  the 
public  health,  the  subject  of  diseased  meats  has 
attracted  great  attention,  an  1  a  bill  has  been  in- 
troduced into  Parliament  designed  to  effect  the 
desired  reform.  From  a  speech  in  Parliament, 
by  Mr.  Bruce,  some  instructive  facts  were  devel- 
oped in  regard  to  the  diseases  of  cattle.  He 
stated  that  statistical  tables  show  that  in  the  sis 
years  from  1855  to  1360  inclusive,  the  average 
annual  mortality  among  cattle  was  nearly  five 
per  cent. ;  the  annual  death-rate  for  sheep  is  esti- 
mated at  four  per  cent.     In  regard  to  pigs,  the 


DISEASED   3IEATS.  183 

estimated  loss  in  Ireland  is  ten  per  cent.;  in 
England  and  Scotland  it  is  much  less.  The  most 
fatal  of  diseases  is  pleuro-pneumonia,  from 
which  at  least  half  of  the  cattle  died.  He 
stated  that  an  enormous  mass  of  diseased  meat, . 
in  various  stages  of  disease,  is  annually  sold. 
What  the  precise  quantity  is  it  would  of  course 
be  difficult  to  estimate.  Professor  Gamgee  esti- 
mated it  at  one-fifth.  There  is  no  conclusive 
evidence  on  the  subject,  although  there  is  ample 
evidence  that  the  quantities  are  very  large,  not 
only  of  meat  killed  while  cattle  were  diseased, 
but  of  cattle  which  had  died  without  the  aid  of 
the  butcher.  Mr.  Bruce  took  the  case  where  the 
figures  were  beyond  dispute.  The  deaths  in 
dairies  are  most  numerous.  In  Edinburgh  Pro- 
fessor Gamgee  gave  returns  from  eighty-eight 
dairies,  and  states  that  he  found  that  out  of  1,839 
cows  kept,  1,075  were  sold  diseased,  of  which 
791  were  sold  to  butchers,  and  281  to  be  con- 
sumed by  pigs.  In  nine  dairies  in  Dublin,  on  an 
average  of  twenty  years,  out  of  315  cows,  161 
were  sold  diseased.     Professor  Gamgee  says  : 

"  In  London  I  have  seen  butchers  in  private  slaughter- 
houses dress  extremely  diseased  carcasses  and  '  polish '  the 
meat.  This  filthy  practice  consists  in  killing  a  good  fat 
ox,  at  the  same  time  that  a  number  of  lean  and  diseased 
animals  are  being  killed.  Boiling  water  is  at  hand,  and 
when  the  lean  animals  have  been  skinned  their  flesh  is 
rubbed  over  with  fat  from  the  healthy  ox.  and  hot  coths 
are  used  to  keep  the  fat  warm,  and  to  distribute  it  over 
the  carcass,  that  it  may  acquire  an  artificial  gloss  and  an 


184  DISEASED   MEATS. 

appearance  of  not  being  totally  deprived  of  fat.  In 
Edinburgh  I  have  seen  sickly  lambs  without  a  particle 
of  fat  upon  them  dressed  up  with  the  fat  of  healthy  sheep, 
much  in  the  same  way.  From  the  private  slaughter- 
houses in  London  I  have  known  even  the  diseased  organs 
themselves  sent  to  the  sausage-maker.  In  company  with 
another  member  of  my  profession,  I  have  seen  a  carcass 
dressed  and  portions  of  it  prepared  for  sale  as  sausage- 
meat,  and  otherwise,  although  thoracic  disease  had  gone 
to  such  an  extent  that  gallons  of  fetid  fluid  were  removed 
from  the  pleural  sacs,  and  that  large  abscesses  existed  in 
the  lungs." 

In  Edinburgh  there  were  between  one  hun- 
dred and  two  hundred  diseased  cattle  sold  weekly 
in  the  market.  At  a  meeting  of  the  Eojal  Dub- 
lin Society,  Mr.  Ganley,  salesmaster,  said  :  "  That 
unless  some  means  were  devised  to  give  the 
farmer  some  compensation  for  diseased  cattle,  it 
was  impossible  to  prevent  him  from  selling  iheni, 
or  the  butcher  from  killing  and  selling  them. 
Unless  some  society  were  formed  to  have  dis- 
eased meat  paid  for,  it  would  be  killed  and  eaten. 
There  wras  no  use  in  mincing  the  matter ;  every 
one  of  the  salesmen  sold  diseased  cattle.  The 
farmer  could  not  otherwise  pay  his  rent.  The 
disease  is  so  prevalent  that  he  could  not  live 
were  he  to  submit  his  cattle  to  destruction."  The 
deleterious  effect  of  diseased  meat  upon  the  pub- 
lic health  is  established  by  the  concurrent  testi- 
mony of  the  best  medical  observers.  Professor 
Maclagan,  of  the  University  of  Edinburgh,  stated 
at  a  public  meeting  held  at  Edinburgh  on  the 


DISEASED   MEATS.  185 

29tli  of  January,  1862,  that  in  his  practice,  both 
as  a  physician  and  a  toxicologist,  he  had  met 
with  instances  in  which  several  persons  had  been 
attacked  simultaneously  with  irritant  symptoms 
after  having  in  common  partaken  of  meat  which,  on 
being  examined,  was  found  to  contain  no  poison, 
nor  to  be  in  that  state  of  putrescence  which,  as 
is  well  known,  occasionally  confers  upon  animal 
matters  actively  poisonous  properties.  Dr.  Al- 
fred S.  Taylor,  F.B.S.,  an  eminent  toxicologist, 
said  : 

''Asa  general  principle,  I  think  diseased  meat  noxious 
and  unfit  for  human  food.  In  the  course  of  my  practice  I 
have  met  with  several  cases  of  poisoning  which  appeared 
to  be  attributable  to  diseased  or  decomposed  meat — more 
frequently  the  latter.  I  can  at  present  recall  to  my  recollec- 
tion only  two  fatal  cases — one  from  diseased  mutton,  the 
sheep  having  had  the  staggers,  and  one  from  German  sau- 
sages. Animal  food  has  been  frequently  sent  to  me  with 
a  view  to  the  detection  of  poison,  the  persons  sending  it 
having  the  impression  that  from  the  vomiting  and  purg- 
ing produced  poison  must  have  been  mixed  with  it.  No 
poison  has,  however,  been  found  to  justify  this  suspicion." 

Dr.  Letheby,  Health  Officer  of  London,  stated  : 

'•  My  opinion  of  the  injurious  effects  of  diseased  meat 
on  the  health  of  those  who  make  use  of  it  is  very  decided. 
I  have  seen  so  much  mischief  from  it  that  I  do  not  hesi- 
tate for  one  moment  to  say  that  some  legislative  measure 
is  most  pressingly  wanted  to  prevent,  not  only  the  traffic 
in  diseased  meat,  but  also  to  prevent  the  slaughtering  of 
diseased  animals.  Such  regulations  are  now  in  operation 
everywhere  on  the  Continent,  and  they  are  much  needed 
here.     In  the  city  markets  alone  my  officers  seize  from  one 


186  DISEASED   MEATS. 

to  two  tons  of  diseased  meat  every  week.  Last  year  we 
seized  110,046  lbs.  of  meat,  of  which  78,697  lbs.  were  dis- 
eased, and  13,944  lbs.  from  animals  that  had  died.  "We 
often  pursue  the  offenders  into  a  court  of  justice,  and  have 
them  fined  or  imprisoned  ;  but  I  feel  that  the  mischief 
should  be  stopped  before  it  reaches  the  markets.  Officers 
are  wanted  to  examine  the  cattle  before  they  are  slaugh- 
tered. As  to  the  effects  of  such  meat  on  the  human  sub- 
ject, I  have  seen  many  cases  of  illness  from  it.  One  of 
these  is  sufficiently  important  to  bring  under  your  notice. 
In  the  month  of  November,  1860,  a  part  of  a  diseased  cow 
was  bought  in  Newgate  market.  It  came  from  one  of  the 
cow-houses  in  London.  It  was  bought  by  a  sausage-maker 
of  Kingsland,  and,  as  is  commonly  the  case  with  very  bad 
meat,  it  was  made  up  into  sausages.  Sixty-six  persons 
partook  of  the  sausages,  and  sixty-four  of  them  were  made 
very  ill.  They  were  purged,  became  sick,  giddy,  and  the 
vital  powers  were  seriously  prostrated,  and  they  lay  in 
many  cases  for  hours  in  a  case  of  collapse,  like  people 
with  cholera.  One  man  died,  and  I  was  requested  by  the 
coroner  to  inquire  into  the  matter.  I  obtained  some  of 
the  sausages,  thinking  that  a  mineral  poison  might  be 
present,  but  I  could  discover  none;  and  the  whole  history 
of  the  case  showed  that  it  was  diseased  meat  which  had 
done  the  work.  Again,  Dr.  Livingstone  tells  us  that  when- 
ever the  natives  of  Africa  eat  the  flesh  of  an  animal  that 
has  died  from  pleuro-pneumonia,  no  matter  how  the  flesh 
is  cooked,  they  suffer  from  carbuncle.  Now,  it  is  a  very 
remarkable  fact  that  boils  and  carbuncles  have  been  most 
prevalent  in  this  country  for  several  years  past.  The  Reg- 
istrar-General for  Scotland  has  drawn  attention  to  this 
fact." 

And  Professor  Gamgee  said  : 

"  My  own  observations  confirm  the  opinions  of  the  emi- 
nent authorities  just  quoted.  I  have  known  in  many  in- 
stances where  meat  supplied  to  students  in  lodging-houses 


DISEASED   MEATS.  187 

in  tins  city  has  led  to  vomiting,  purging,  and  severe  colic. 
In  the  majority  of  instances  such  meat  was  cooked  in  the 
form  of  beefsteak.  Three  of  my  own  students  were 
affected  simultaneously  one  day  in  December  last.  With- 
in a  couple  of  hours  after  dinner  they  experienced  colicky 
pains,  purging,  vomiting,  and  these  symptoms  lasted  sev- 
eral hours.  Bread,  potatoes,  and  water  were  the  only  other 
materials  they  had  partaken  of  at  dinner.  On  another 
occasion  two  were  affected,  but  did  not  attribute  the  in- 
jury to  the  steak  until  the  next  day,  when  the  servant  ate 
what  had  been  left  of  the  meat,  and  suffered  severely." 

Such  startling  facts  should  awaken  the  atten- 
tion of  every  community  that  has  to  depend  upon 
a  general  market  for  its  meats.  In  this  city  we 
believe  the  evil,  if  known,  would  be  truly  alarm- 
ing. But  without  any  organized  plan  to  prevent 
the  sale  of  improper  foods,  the  market-men  have 
it  their  own  way,  and  even  go  so  far  as  to  retail 
such  articles  on  the  street.  "Meat  for  board- 
ers "  was  for  a  long  time  the  suggestive  "  sign  " 
overhanging  a  large  meat-stall  in  the  neighbor- 
hood of  the  sailors'  boarding-houses.  In  plain 
words  it  would  have  read  :  "  Diseased  meat  sold 
cheaply."  The  remedy  for  this  evil  is  to  be 
found  in  the  organization  of  bureaux  for  food  in- 
spection. Slaughtering  should  be  concentrated 
in  well-appointed  abattoirs,  and  skilled  inspectors 
should  examine  every  animal  before  and  during 
the  process  of  slaughtering.  All  diseased  ani- 
mals and  affected  carcasses  would  thus  be  ex- 
cluded from  market,  and  this  terrible  crime 
against  the  laboring  classes  would  be  effectually 
prevented. 


XXXVI. 
MOTS  AND  THEIR  PREVENTION. 


AMONG  the  improvements  which  the  late 
Emperor  of  France  is  said  to  have  in" 
troduced  into  Paris,  was  the  removal  of  a  large 
group  of  thickly  clustered  but  dilapidated  and 
wretched  tenement  houses,  and  the  conversion  of 
the  site  into  a  public  square.  The  work  was  un- 
dertaken ostensibly  to  beautify  that  portion  of 
the  city.  Those  familiar  with  the  history  of 
these  abodes  of  poverty,  however,  remember  this 
locality  as  the  place  where  have  originated  many 
of  the  most  terrible  riots  with  which  that  city 
has  been  visited ;  and  they  shrewdly  suspect  that 
the  real  motive  of  the  Emperor  was  to  destroy 
the  nidus  of  future  mobs  and  revolutionary  move- 
ments. The  example  is  one  worthy  of  imitation, 
in  all  large  cities.  In  July,  1863,  New  York 
passed  through  one  of  those  ordeals  of  anarchy 
so  common  in  European  cities  during  civil  com- 
motions. Within  a  few  hours  of  the  commence- 
ment of  riotous  proceediugs  the  civil  authorities 
were  completely  overcome,  and  in  the  universal 
agitation  of  society  the  very  dregs  seemed  to 
float  to  the  surface,  and  surged  to  and  fro  along 
the  streets  and  avenues,  uncontrollable  elements 


RIOTS   AND   THEIR   PREVENTION.  189 

of  destruction.  Business  was  suspended;  pub- 
lic conveyances  ceased  their  rounds ;  places  of 
public  amusement  were  deserted,  and  a  pall  of 
gloom  liuug  over  the  city  as  if  some  terrible  judg- 
ment was  impending.  Few  citizens  were  seen 
abroad,  but  at  every  turn  were  groups  of  persons 
seldom  if  ever  before  met  in  the  more  respecta- 
ble parts  of  the  town.  Their  garments  were 
ragged  and  filthy,  and  their  faces,  stamped  with 
every  crime,  gleamed  with  the  ferocity  of  un- 
bridled passions.  Individual  acts  of  violence  oc- 
curred on  every  hand,  and  this  terrible  carnival 
of  murder  and  arson  culminated  on  the  first  day 
in  a  grand  ovation  to  the  demon  of  the  mob  in 
the  conflagration  of  an  orphan  asylum  over  the 
heads  of  several  hundreds  of  helpless,  homeless, 
and  fatherless  children.  No  mob  can  show  a 
blacker  record  than  that  which  disgraced  New 
York  on  July  14,  15,  and  16,  1863.  The  various 
political  and  social  phases  of  this  great  riot  was 
largely  discussed  in  the  daily  papers,  but  there 
are  some  things  worthy  of  record  as  gathered 
from  a  professional  stand-point.  It  is  a  noticea- 
ble fact  that  the  rioters  represented  for  the  most 
part  the  lowest  and  most  abandoned  class  of  the 
poor.  They  proceeded  from  those  districts  of 
the  city  notorious  for  their  filthy  and  unpoliced 
streets,  and  wretched  and  uninhabitable  tene- 
ment houses.  Here  live  and  grovel  in  darkness, 
filth,  drunkenness,  and  disease,  a  large  popula- 
tion, roughly  estimated  at  twenty  thousand.     The 


190  RIOTS  AND   THEIR  PREVENTION. 

following  description  of  this  class,  as  drawn  by 
Mr.  N.  P.  Willis,  an  eyewitness  to  the  scenes  of 
arson  and  murder  during  the  riot,  will  be  recog- 
nized as  truthful  by  every  physician  whose 
duties  may  have  led  him  into  these  abodes  of 
wretchedness : 

"  The  high  brick  blocks  and  closely  packed  houses  in 
this  neighborhood  seemed  to  be  literally  hives  of  sickness 
and  vice.  Curiosity  to  look  on,  at  the  fire  raging  so  near 
them,  brought  every  inhabitant  to  the  porch  or  window, 
or  assembled  them  in  ragged  and  dirty  groups  on  the  side- 
walk in  front.  Probably  not  a  creature,  who  could  move, 
was  left  in-door  at  that  hour.  And  it  is  wonderful  to  see, 
and  difficult  to  believe,  that  so  much  misery,  and  disease, 
and  wretchedness,  can  be  huddled  together  and  hidden  by 
high  walls,  unvisited  and  unthought  of,  so  near  our  own 
abodes.  The  lewd,  but  pale  and  sickly  young  women, 
scarce  decent  in  their  ragged  attire,  were  impudent,  and 
scattered  everywhere  in  the  crowd.  But  what  numbers  of 
these  poorer  classes  are  deformed,  what  numbers  are  made 
hideous  by  self-neglect  and  infirmity,  and  what  numbers 
are  jjaralytics,  drunkards,  imbecile,  or  idiotic,  forlorn  in 
their  poverty-stricken  abandonment  for  this  world  !  Alas  ! 
human  faces  look  so  hideous  with  hope  and  vanity  all 
gone  !  And  female  forms  and  features  are  made  so  fright- 
ful by  sin,  squalor,  and  debasement.  To  walk  the  streets 
as  we  walked  them,  for  those  hours  of  conflagration  and 
riot,  was  like  a  fearful  witnessing  of  the  day  of  judgment, 
with  every  wicked  thing  revealed,  every  sin  and  sorrow 
blazingly  glared  upon,  every  hidden  horror  and  abomina- 
tion laid  bare,  before  hell's  expectant  fire." 

It  was  also  noticeable  that  wrhile  business  was 
generally  suspended,  every  establishment  where 
liquor  is  sold  was  open,  and  crowded  with  cus- 


RIOTS  AND  THEIR  PREVENTION.  191 

tomers.     Many  of  the  more  central  grogshops 
had  been  previously  supplied  with  money  by  the 
chief  conspirators,  and  were  directed  to  give  the 
crowd  unstinted  measure  whenever  it  made  its 
demand.     This  was   done,   and  it  is  due  prin- 
cipally to  liquor  that  the  inhuman  barbarities 
were  practiced  upon  individuals,  and  many  of 
the  attempts  at  arson  were  made.     Hundreds  of 
industrious  laborers  driven  from  their  work,  and 
left  to  wander  about  the  streets,  were  thus  made 
fiends  of  the  most   mahcious  and  daring  kind. 
Scarcely   an   overt   act   of  violence  was  perpe- 
trated that  was  not  directly  traceable  to  intoxi- 
cation.    It  would  be  lamentable,  indeed,  if  the 
fearful  lesson  which  this  deeply  laid  conspiracy 
against  the  property  and  lives  of  our  citizens  has 
taught  were  allowed  to  pass  unimproved .     Trans- 
parent as  is  its  political  significance,  its  social 
bearings  are  not  less  clear.     We  learn  the  source 
from  which  must  spring  every  lawless  outbreak 
against   order,  law,    and  the   peace   of  society. 
The  elements  of  pojmlar  discord  are  gathered  in 
those  wretchedly  constructed  tenement  houses, 
where   poverty,    disease,    and    crime   find   a   fit 
abode.     Here  disease  in  its  most  loathsome  form 
propagates  itself  from  parent  to  child,  more  and 
more    aggravated   with    each   generation.     De- 
formities  of   the   body,   typical   of  mental  and 
moral  aberrations,  are  seen  in  every  household. 
Unholy   passions    rale   in  the   domestic   circle. 
Trained  in  such  a  school,  children  grow  up  desti- 


192  RIOTS   AND   THEIR   PREVENTION. 

tute  of  every  generous  impulse,  and  habituated  to 
scenes  of  cruelty  and  vice.  Everything  within 
and  without  tends  to  physical  and  moral  degra- 
dation. The  noisome  atmosphere  which  they 
breathe,  the  scanty  and  innutritious  food  which 
they  eat,  combine  to  dwarf  the  body  and  mind 
and  lead  to  the  most  vicious  habits.  Here,  in 
the  tenement  houses  of  our  city,  we  find  the 
seeds  of  civil  discord,  of  every  species  of  vice 
and  crime,  always  ready  to  germinate  with  the 
slightest  stimulation.  Relax  the  legal  restraints 
which  surround  the  tenants  of  whole  blocks  of 
buildings,  and  madden  them  with  rum,  and  they 
rush  forth  prepared  to  commit  the  most  fiendish 
acts.  As  long  as  New  York  disregards  the  home- 
life  of  this  class  of  the  poor,  she  nourishes  in  her 
bosom  a  viper  which  any  day  may  inflict  a  fatal 
wound.  The  great  and  patent  prevention  for 
riots  like  that  which  we.  have  witnessed  is  radical 
reform  of  the  homes  of  the  poor.  No  family 
circle  can  be  practically  virtuous  which  grovels 
in  the  cellar  or  the  garret,  deprived  of  the  sun- 
light and  fresh  air;  nor  can  a  family  be  very 
vicious  which  enjoys  airy  and  spacious  rooms, 
and  is  surrounded  by  the  health-giving  influ- 
ences of  pure  air,  sunlight,  cleanliness,  and  thrift. 
Says  Dr.  Southwood  Smith,  England's  great  san- 
itary reformer  : 

"  A  clean,  fresh,  well-ordered  house  exercises  over  its  in- 
mates a  moral,  no  less  than  a  physical  influence,  and  has  a 
direct  tendency  to  make  the  members  of  the  family  sober, 


RIOTS  AND   THEIR  PREVENTION.  193 

peaceable,  and  considerate  of  the  feelings  and  happiness 
of  each  other;  nor  is  it  difficult  to  trace  a  connection  be- 
tween habitual  feelings  of  this  sort  and  the  formation  of 
habits  of  respect  for  property,  for  the  laws  in  general,  and 
even  for  those  higher  duties  and  obligations  the  observ- 
ance of  which  no  law  can  enforce." 

With  equal  truth,  Mr.  Kawlinson,  in  his  ad- 
dress before  the  Social  Science  Association,  said  : 

"  Defective  house  accommodations  produce  disease,  im- 
morality, pauperism  and  crime,  from  generation  to  genera- 
tion, until  vice  has  become  a  second  nature,  and  morality, 
virtue,  truth  and  honesty,  are,  to  human  beings  so  de- 
based, mere  names." 

Every  family  in  this  city  should  be  accommo- 
dated with  an  ample  and  suitably  arranged  dom- 
icil.  The  old  rookeries  in  crowded  and  filthy 
districts  should  be  destroyed,  and  new  and 
commodious  houses  built.  Tenement  houses  can 
be  made  convenient  for  families,  with  sufficient 
air-space  and  sunlight,  proper  rooms  for  cook- 
ing, eating,  and  sleeping,  and  still  be  remuner- 
ative. But  no  landlord  will  consult  the  wants  of 
his  tenants  until  compelled  to  do  so  by  the  rigid 
enforcement  of  law.  To  accomplish  this  neces- 
sary and  imperative  reform,  the  proper  authori- 
ties should  cause  the  improvement,  and,  as  far  as 
possible,  the  reconstruction  of  tenement  houses, 
the  opening  of  streets  through  densely  popu- 
lated districts,  and  the  laying  out  of  parks.  Said 
Lord  Shaftesbury  at  the  Society  of  Arts  (April 
21,  1871)  in  encouragement  of  this  reform  : 

"  Work  on  till  every  workman  should  have  three 
9 


194  RIOTS   AND   THEIR  PREVENTION. 

good  rooms,  well  ventilated,  and  with  light  before 
and  behind.  These  were  the  requirements  which  were 
necessary  for  a  Christian  and  a  civilized  being.  Any- 
thing that  would  moderate  these  evils,  however  humble  it 
might  be ;  anything  that  would  deal  with  the  miserable, 
disgusting,  alarming  condition— alarming  in  a  physical, 
moral,  and  spiritual  sense,  as  well  as  in  a  political  sense — 
of  hundreds  and  thousands  of  people  in  this  great  and 
wealthy  metropolis,  should  be  welcomed  and  encouraged." 

It  is  important,  also,  that  the  retail  of  ardent 
spirits  should  be  placed  under  more  stringent 
regulations.  At  present  the  largest  license  is 
given,  or  at  least  taken,  and  a  rising  mob  finds 
at  every  corner  the  maddening  draught  awaiting 
its  arrival.  Dram-drinking,  like  prostitution,  is 
one  of  those  terrible  social  evils  which  every 
philanthropist  wishes  blotted  out  of  existence 
but  which  is  still  subjected  to  only  a  very  modi- 
fied control.  This  control  should  be  more  abso- 
lute than  at  present.  Alchohol,  like  opium, 
should  be  regarded  as  a  medicinal  agent,  to  be 
administered  only  under  medical  advice.  Pro- 
hibitory laws  against  its  sale  as  a  common  article 
of  trade,  are  founded  in  justice,  and  have  regard 
to  the  highest  interests  of  the  individual,  of  so- 
ciety, and  of  the  State.  If  such  stringent  laws 
are  not  enacted,  there  is  an  absolute  necessity 
that  in  times  of  popular  excitement  at  least 
every  grog-shop  should  be  closed,  and  the  sale  of 
liquors  made  penal. 


XXXVII. 

EDUCATION    OF   INFANTS. 


A  CHILD  about  four  years  of  age  recently 
died  suddenly  in  a  public  school  under 
the  following  circumstances,  as  narrated  in  the 
public  prints  :  "  It  is  the  habit  of  the  teachers  of 
that  school  to  detain  after  hours  such  of  the 
pupils  as  may  have  been  deficient  in  their  les- 
sons during  the  day.  Upon  the  occasion  in 
question  the  deceased,  with  twelve  other  scholars, 
was  kept  in.  Deceased  seemed  to  take  the  pun- 
ishment very  seriously,  and  asked  her  teacher  to 
allow  her  to  go.  The  teacher,  noticing  her  agi- 
tation, kindly  told  her  that  she  might  go  as  soon 
as  she  was  able  to  spell  correctly  the  word 
"  hedge."  This  appeared  to  appease  her,  and 
she  went  to  her  seat.  Soon,  however,  it  was  ob- 
served that  the  child  threw  her  head  back,  and 
was  gasping  for  breath.  The  teacher  took  her  in 
her  arms  and  did  all  she  could  to  relieve  her,  but 
after  three  or  four  spasms  she  expired."  We 
have  in  this  case  a  sad  but  instructive  commen- 
tary upon  the  evils  of  the  American  educational 
system.  A  child  but  four  years  of  age  is  found 
at  school,  and  is  not  only  required  to  perform  a 
given  mental  task,  but  is  also  subjected  to  the 


196  EDUCATION  OF  INFANTS. 

rigid  discipline  of  the  oldest  scholars.  Over- 
come by  fear  or  grief,  she  falls  into  a  syncope 
from  which  she  never  rallies.  Such  a  singular 
phenomenon  may  well  astonish  the  community. 
It  were  well  for  the  rising  generation  if  the  les- 
son it  teaches  led  to  reformation  in  the  manage- 
ment of  children.  It  is  surprising  at  what  a 
tender  age  children  are  placed  in  school,  and 
brought  under  the  restraints  of  a  worse  than 
prison  discipline.  At  that  period  of  childhood, 
or  rather  of  infancy,  when  during  its  waking 
hours  every  muscle  naturally  requires  activity 
and  free  play  for  its  proper  development,  the 
child  is  compelled  to  sit  for  hours  as  unmoved 
as  a  statue.  But  to  this  cruel  restraint  we  have 
the  additional  evil  that  the  child  is  confined  to  a 
room  the  atmosphere  of  which  is  infected  with 
poisonous  gases  and  foul  exhalations  from  hu- 
man bodies.  The  conditions  necessary  to  retard 
the  growth  and  development  of  the  child  are 
complete,  and  the  result  is  always  accomplished. 
We  see  many  of  the  effects  of  such  training  in 
the  feeble  bodies,  dwindled  legs  and  arms, 
curved  spines,  and  nameless  other  deformities  of 
adolescents.  But  how  many  unseen  and  unap- 
preciated vices  of  development  and  growth  are 
created  by  these  causes !  How  destructive  to 
the  delicate  organization  of  the  nervous  system 
is  such  training  of  the  child,  and  how  sadly  are 
its  functions  perverted  !  In  the  case  related  we 
see  how  seriously  the  nervous  system  had  be- 


EDUCATION   OF  INFANTS.  197 

come  weakened,  and  how  slight  a  cause  com- 
pletely overpowered  it.  We  may  well  believe 
that  this  poor  child  is  but  a  type  of  the  children 
of  our  schools.  Though  such  a  melancholy  ter- 
mination of  their  pupilage  is  rare,  yet  thousands 
of  children  are  doubtless  brought  to  the  very 
verge  of  the  grave  by  the  unhealthy  influences 
acting  upon  their  susceptible  organizations.  The 
vital  question  recurs  :  At  what  age  should  a 
child  be  sent  to  school  ?  There  can  be  no  doubt 
that  previously  to  the  ages  of  six  or  seven  the 
child  should  neither  be  subjected  to  systematic 
physical  restraint,  nor  should  its  mind  be  tasked 
with  appointed  lessons.  The  full  and  perfect  de- 
velopment of  the  body  is  a  more  important  end 
to  be  attained  in  the  training  of  the  child  than 
the  cultivation  of  its  mind.  That  system  of  edu- 
cation is  perfect  which  secures  these  two  objects. 
Previously  to  the  age  which  we  have  fixed  a 
child  may  be  an  apt  scholar,  though  free  from 
all  bodily  restraint.  The  cultivation  of  the 
powers  of  the  body  and  mind  may  go  together, 
and  is  productive  of  the  very  best  results.  We 
see  in  the  Kindergarten  of  the  Germans  the  very 
perfection  of  this  system  of  training.  Here  the 
infant  is  free  to  play  and  romp  in  the  open  air, 
amid  a  profusion  of  flowers,  or  on  the  grass 
lawn,  watched  by  a  careful  and  tender  nurse, 
who  acts  at  the  same  time  as  teacher.  While 
the  child  revels  in  the  pure  air  and  sunshine,  it 
imperceptibly  learns  the  lesson  of  the  day.     But 


198  EDUCATION   OF  INFANTS. 

though  we  are  unable  to  place  a  child  in  a  school 
so  favorable  for  its  due  and  proper  training,  a 
faithful  parent  may  accomplish  much  by  per- 
sonal instruction  while  the  child  still  enjoys  the 
most  perfect  freedom.  In  commenting  upon  this 
subject,  Dr.  Ray,  a  very  able  writer  has  said  : 

"Instinctively  the  young  child  seeks  for  knowledge  of 
some  kind,  and  its  spontaneous  efforts  may  be  safely  al- 
lowed. With  a  little  management,  indeed,  they  may  be 
made  subservient  to  very  important  acquisitions.  In  the 
same  way  that  it  learns  the  names  of  its  toys  and  play- 
things, it  may  learn  the  names  of  its  letters,  of  geometrical 
figures,  and  objects  of  natural  history.  There  can  be  but 
little  danger  of  such  exercises  being  carried  too  far.  But 
the  discipline  of  school,  if  obliging  the  tender  child  to  sit 
upright  on  an  uncomfortable  seat  for  several  hours  in  the 
day,  and  con  his  lessons  from  a  book,  is  dangerous  both  to 
mind  and  body.  To  the  latter,  because  it  craves  exercise 
almost  incessantly,  and  suffers  pain,  if  not  distortion,  from 
its  forced  quietude  and  unnatural  postures.  To  the  for- 
mer, because  it  is  pleased  with  transient  emotions,  and 
seeks  for  a  variety  of  impressions  calculated  to  gratify  its 
perceptive  faculties.  The  idea  of  study  considered  in  re- 
lation to  the  infant  mind,  of  appropriating,  assimilating 
the  contents  of  a  book,  of  performing  mental  processes 
that  require  a  considerable  degree  of  attention  and  abstrac- 
tion, indicates  an  ignorance  of  the  real  constitution  of  the 
infant  mind,  that  would  be  simply  ridiculous,  did  it  not 
lead  to  pain,  weariness,  and  disgust.  And  such  is  the 
strange  abandonment  of  all  practical  common  sense  on  this 
subject,  that  many  a  person  fails  to  view  this  practice  in  its 
true  light,  who  would  never  commit  the  folly  of  beginning 
the  training  of  a  colt  by  taking  it  from  the  side  of  its  dam, 
harnessing  it  to  a  cart  or  plow,  and  keeping  it  at  work 
through  a  sultry  summer's  day." 


XXXYIIL 
PHYSICIANS    IN    OLD    AGE. 


ASUEGEON  once  remarked,  very  shrewdly, 
that  "few  medical  men  grow  old  grace- 
fully." The  remark,  doubtless,  had  reference  to 
the  pertinacity  with  which  our  elder  brethren 
cling  to  business,  and  to  those  public  positions 
which  they  have  ceased  to  fill  creditably.  This 
fact  has,  doubtless,  the  greatest  significance  to 
the  aspiring  young  practitioner.  As  he  plods 
along  his  wearisome  way  to  make  his  single  daily 
visit,  and  that  too  often  to  a  charity  patient,  he 
conceives  the  greatest  contempt  for  the  grasping 
ambition  of  the  white-haired  septuagenarian  who 
dashes  past  over  roads  which  he  has  traveled 
half  a  century,  to  the  families  of  the  wealthy. 
But  in  the  eyes  of  all  men  his  position  is  not 
enviable  who,  crowned  with  wealth  and  honor, 
toils  on,  as  does  many  a  medical  man,  unmindful 
of  the  shadows  of  the  evening  which  are  gather- 
ing thickly  about  him.  The  question  is  occa- 
sionally asked  by  members  of  other  professions, 
"  At  what  age  do  medical  men  retire  from  active 
life  ?"  The  only  answer  which  can  be  given  is, "  at 
that  age  at  which  death  overtakes  them."  If  it  is 
honorable  to  die  with  the  harness  on,  without  a 


200  PHYSICIANS  IN   OLD  AGE. 

moment's  interval  in  which  to  compose  the  mind 
for  the  great  and  eternal  change,  our  profession 
is,  of  all  others,  the  most  worthy  of  the  distinc- 
tion. Seldom  do  we  have  an  example  of  a  suc- 
cessful physician  who  has  retired  voluntarily 
from  his  business  with  health  and  faculties  unim- 
paired. Medical  men  there  are  in  retirement, 
but  they  have  not  sought  seclusion  from  a  philo- 
sophical view  of  the  amenities  of  age,  but  be- 
cause they  could  no  longer  pursue  their  avoca- 
tions. Unless  some  unlucky  accident  or  unfor- 
tunate cerebral  attack  so  far  destroy  their 
powers  of  locomotion,  as  to  render  their  visits  to 
their  patients  positively  objectionable,  our  older 
brethren  pursue  their  daily  and  even  nightly 
duties  far  past  the  period  of  life  at  which 
men  in  other  employments  seek  the  repose 
which  is  generally  grateful  to  old  age.  In  the  hot 
strife  for  business,  we  meet  the  veteran  side  by 
side  with  the  graduate  fresh  from  the  schools. 
No  toil  or  sacrifice  of  personal  comfort  can  in- 
duce him  to  relax  his  efforts  to  maintain  his  hold 
upon  his  families,  and  to  enlarge  the  circle  of  his 
practice.  If  we  pass  from  the  circle  of  private 
to  the  more  responsible  duties  of  public  practice, 
we  find  medical  men  who  have  passed  the  period 
at  which  the  mental  and  physical  powers  begin 
to  decline,  still  occupying  stations  which  they 
have  long  ceased  to  honor.  In  many  hospitals 
there  are  medical  attendants,  infirm  with  age, 
clinging,  with  a  grasp  that  only  death  will  loose, 


PHYSICIANS  IN   OLD  AGE.  201 

to  positions  which  demand  the  activity  and  effi- 
ciency of  middle  life.     The  practitioner  who  has 
reached  that  age  at  which,  in  his  own  estimation, 
he  requires  no  further  light,  and  discards  the 
teachings  of  contemporary  science,  should  retire 
to  the  shades  of  private  life.     He  may  continue 
a  respectable  practitioner,  but  he  does  not  do" 
full  justice  to  his  patients.     Unfortunately,  this 
is  the  precise  age  at  which  all  physicians  believe 
that  they  are  most  competent.     They  now  rely 
upon  their  experience  and  grey  hairs,  the  latter 
being  often  the  more  valuable  of  the  two.     If  a 
physician  who  has  passed  into  his  dotage  is  unfit 
to  practice  his  profession,  how  much  more  unfit 
is  he  to  instruct  the  rising  generation  of  prac- 
titioners ?    It  is  little  less  than  madness  to  allow 
such  persons  to  fill  important  chairs  in  medical 
colleges.     The  pupil  must  subsequently  unlearn 
all  that  he  has  learned  from  such  sources  before 
he  can  become  a  successful  student  of  the  med- 
ical sciences.     It  is  not  to  be  denied  that  phy- 
sicians may  continue  to  improve  in  their  pro- 
fession to  a  great  age.     There  are  striking  ex- 
amples in  history  of  men  who,  though  far  ad- 
vanced  in   life,    became    proficients   in   various 
kinds  of  learning.     And,  in  our  own  profession, 
Brodie,  in  England,  and  Mott,  in  this  country, 
were  pleasing  exceptions  to  the  general  rule,  that 
medical  men  cease  early  to  advance  with  the  sci- 
ence they  are  called  upon  to  apply  to  daily  practice. 
But  nevertheless,  it  is  true,  that  the  vast  major- 


202  PHYSICIANS   IN   OLD  AGE. 

ity  of  physicians  cease  to  learn  after  the  age  of 
sixty  or  sixty-five,  and  too  frequently  begin  to 
ridicule  all  recent  discoveries.  The  conclusions 
which  are  to  be  drawn  from  the  foregoing  reflec- 
tions are  :  1.  Medical  men  do  not  retire  from 
business  at  a  sufficiently  early  age.  They  are 
too  much  disposed  to  struggle  to  maintain  a 
practice,  when  they  have  actually  ceased  to  be 
competent  practitioners.  In  general  a  physician 
at  sixty-five  is  never  as  correct  a  practitioner  as 
at  forty,  and  thereafter  he  rapidly  degenerates 
with  advancing  age.  2.  Old  medical  men  should 
not  retain  public  positions.  In  France  a  phy- 
sician or  surgeon  is  compelled  to  withdraw  from 
hospital  practice  at  sixty.  This  is  a  most  right- 
eous regulation,  and  should  be  enforced  in  every 
hospital.  Aside  from  their  incompetence,  the  old 
men  do  great  injustice  to  the  young,  who  have 
time  and  talents  to  improve  the  advantage  of 
hospital  practice,  by  retaining  these  places  long 
after  they  cease  to  improve  them.  And  finally, 
it  is  most  to  be  regretted  that  our  schools  retain 
men  in  their  professorships  who  are  represen- 
tatives of  past  ages.  We  may  daily  hear  the 
theories  of  a  former  century  discussed  by  these 
antiquated  teachers  with  the  utmost  earnestness 
and  precision.  In  some  medical  schools,  the  sur- 
gery, midwifery-practice,  and  therapeutics  taught, 
belong  to  the  last  half  of  the  eighteenth  century. 
The  reform  which  is  required  is  practicable,  and 
we  hope  some  day  to  see  it  established.     Age 


PHYSICIANS   IN   OLD   AGE.  203 

and  decrepitude  should  not  be  tolerated  in  those 
responsible  positions  which  demand  youthful 
ardor  and  strength.  Medical  senility,  resting  un- 
der the  shadow  of  a  great  name,  sits  in  many  a 
high  place  from  which  it  should  be  cast  out,  to 
give  way  to  those  who  represent  contemporary 
medical  science.  In  our  medical  schools  the  fact 
is,  perhaps,  still  more  apparent  that  medical  men 
seldom  grow  old  gracefully.  Many  chairs  are 
retained  by  professors  who  have  long  ceased  to 
keep  progress  with  the  advance  of  scientific 
investigation.  They  inculcate  theories  which 
have  been  discarded,  and  reject  with  the  conceit 
of  incredulous  old  age  the  recent  demonstrations 
of  science.  We  can,  therefore,  but  regard  it  as 
a  much  needed  reform  in  our  profession,  that 
those  who  have  attained  old  age  and  competence 
should  retire  from  active  and  responsible  duties. 
They  should  not  only  yield  to  the  young  and 
ambitious  the  schools  of  instruction  and  the 
hospitals,  but  also  the  field  of  private  practice. 
We  can  conceive  of  no  position  more  enviable 
than  that  of  the  successful  physician,  who,  recog- 
nizing the  incipient  stages  of  physical  decay, 
gracefully  retires  from  the  active  duties  of  his 
profession,  while  yet  all  respect,  honor,  and  love 
him,  and  enjoys  in  the  shades  of  retirement  the 
enduring  rewards  of  a  well  spent  life.  In  new 
and  peaceful  occupations  his  days  will  be  length- 
ened, while  he  sheds  around  him  the  healthful 
influence  of  a  matured  experience. 


XXXIX. 

FEE    AND    CONTEACT. 


PBOFESSIONAL  remuneration,  perhaps, 
more  vitally  interests  the  mass  of  Ameri- 
can physicians  than  any  other  question  which 
can  be  presented  for  their  consideration.  As  a 
people,  we  are  reputed  to  hold  the  almighty  dol- 
lar in  profound  respect,  and  as  a  profession  we 
are  not  exempt  from  the  national  scandal.  For 
the  most  part  we  have  reduced  the  practice  of 
physic  to  a  mere  matter  of  business.  We  meas- 
ure success  by  the  amount  of  income,  and  are 
strongly  inclined  to  gauge  professional  excel- 
lence by  the  same  standard.  At  the  last  meet- 
ing of  the  Association  for  the  Promotion  of 
Social  Science  (England),  a  communication  was 
read,  which  advocated  the  adoption  of  the  con- 
tract instead  of  the  fee  system  by  the  medical 
profession.  The  plan  recommended  was  to  dis- 
pense with  the  fee  system,  and  to  pay  the  doctor 
so  much  per  annum,  to  include  all  ordinary  work, 
and  a  fee  to  be  paid  for  extraordinary  work. 
Ordinary  work  was  denned  to  mean  periodical 
visits,  attending  to  the  health  of  the  patient, 
etc. ;  and  extraordinary  work  was  held  to  be 
such  exceptional  services  as  calls  to  attend  on 


FEE   AND   CONTRACT.  205 

patients  immediately,  accidents,  and  so  on. 
This  arrangement,  it  was  considered,  would 
make  prevention  as  well  as  cure  the  object  of 
the  doctor's  care,  and  assimilate  the  interests  of 
the  physician  and  patient.  This  question  has 
excited  a  lively  discussion  in  the  medical  jour- 
nals, and  various  are  the  arguments,  pro  and 
con.  On  the  one  hand  it  is  alleged  that  if  the 
physician  make  a  contract  of  this  nature  he  de- 
grades his  calling  to  the  level  of  the  common 
tradesman  ;  that  he  is  liable  to  be  compelled  to 
an  excess  of  duty  by  being  called  when  there  is 
no  need  of  his  services ;  that  it  would  lead  to 
dissatisfaction  of  either  patient  or  physician— of 
patient,  if  there  was  no  sickness  in  the  family, 
and  of  the  physician  if  there  was  too  much  sick- 
ness. In  favor  of  this  plan  it  is  alleged  that  it 
will  "  prevent  many  of  those  disgraceful  insinua- 
tions which  have  been  brought  against  medical 
men  of  '  creating  practice,'  of  paying  unneces- 
sary visits,  of  perverting  hospitalities  to  the  pur- 
pose of  their  profession;  and  when  the  guest 
playing  the  doctor,"  "that  it  would  be  so  far 
mutually  beneficial,  that,  while  the  patient  would 
have  no  hesitation  in  sending  for  the  medical 
attendant  at  the  earliest  indication  of  illness,  the 
practitioner  would,  on  the  other  hand,  feel  no  more 
reserve  in  exercising  his  discretion  in  the  pay- 
ment of  visits,  the  purposes  of  which  could  no 
longer  be  misunderstood."  The  objections  which 
are  urged  to  the  contract  plan  practically  have 


206  FEE  AND   CONTRACT. 

no  foundation.  It  does  not  degrade  the  medical 
attendant  any  more  to  have  a  stipulated  price 
placed  upon  his  annual  services  in  a  family  be- 
fore than  after  that  service  is  rendered.  The 
"  time-honored  and  respected  honorarium,"  so 
sacred  to  many,  has  equal  value  in  both  cases. 
Besides,  how  frequently  does  the  physician  stip- 
ulate to  attend  infirmaries,  dispensaries,  manu- 
factories, and  life  insurances  for  fixed  annual 
salaries.  In  these  instances,  so  common  in  the 
profession  of  every  town,  the  contract  plan  is 
adopted  without  even  the  thought  of  profes- 
sional degradation.  The  allegation  that  it  would 
lead  to  overwork  would  not  prove  true  if  the  con- 
tract exempted,  as  it  ought,  all  special  attend- 
ance, as  at  night,  in  cases  of  accident,  etc.  The 
arguments  in  favor  of  the  contract  plan  are 
plausible,  and  deserve  to  be  well  weighed.  It 
sacures  the  payment  of  the  services  of  the  phy- 
sician much  more  certainly  than  the  fee  system. 
In  a  far  less  number  of  instances  we  are  assured, 
is  the  payment  withheld  under  the  former  than 
under  the  latter  system.  The  obligation  of  the 
patient  may  not  be  any  greater  morally  under 
one  than  under  the  other,  but  legally  he  is  bound 
by  the  contract  to  make  prompt  payment.  The 
freedom  of  the  physician  to  visit  the  family  and 
prolong  his  attendance  upon  the  sick  is  secured 
by  the  contract.  His  visits  are  not  carefully 
noted,  nor  is  it  even  intimated  to  him  that  his 
servicss  are  not  required  in  a  case  of  convales- 


FEE   AND    CONTRACT.  207 

cence.  But,  perhaps,  the  strongest  argument 
that  can  be  adduced  in  favor  of  the  contract  is, 
that  the  physician  assumes  under  it  the  highest 
and  most  dignified  functions  of  his  profession. 
His  aim  now  is  to  prevent  disease ;  he  is  now  not 
always  called  to  cure  the  sick,  but  he  has  a 
higher  duty,  viz.,  that  of  preserving  the  health. 
He  visits  his  families  as  a  hygienist ;  he  attends 
carefully  to  the  conditions  which  surround  the 
family  circle,  and  corrects  any  tendency  to  dis- 
ease. The  dwelling  is  often  examined,  and 
proper  ventilation,  drainage,  etc.,  secured  ;  the 
foods  are  inquired  into,  and  those  selected 
adapted  to  each  member  of  the  family ;  the 
clothing  is  inspected,  the  right  material  advised, 
and  the  proper  style  directed.  In  a  word,  the 
physician  becomes  a  house-to-house  visitant,  ad- 
vising and  directing  in  all  matters  pertaining  to 
the  health  of  the  occupants.  It  can  not  be 
doubtad  that  were  this  system  generally  adopted 
the  sum  of  sickness  and  mortality  would  be 
greatly  diminished.  The  details  of  the  contract 
plan  are  made  up  by  the  parties  themselves. 
The  special  sum  stipulated  must  depend  upon 
the  size  of  the  family,  and  the  conditions  pecu- 
liar to  each.  But  there  is  no  reason  for  making 
the  price  less  than  the  sum  total  of  annual  fees 
under  the  present  system.  The  contract  plan 
has  already  been  adopted  by  some  practitioners 
among  us,  and  is  generally  highly  approved.  If 
universally  approved,  it  may  prove  to  be  a  most 
beneficial  medical  reform. 


XL. 
CEIME    OF    ABORTION. 


THE  appearance  in  the  conits  of  two  abor- 
tionists within  a  short  period,  to  answer  to 
the  charge  of  homicide,  and  the  introduction  of 
a  more  stringent  Act  against  this  crime  into  the 
Legislature  of  New  York,  are  suggestive  of  the 
query — "  How  far  does  this  evil  exist  at  present 
in  American  communities,  and  what  is  the  popu- 
lar opinion  in  regard  to  this  crime?"  If  viewed 
in  the  light  of  an  ancient  civilization,  the  ques- 
tion would  seem  to  have  some  pertinency,  but  it 
appears  the  most  obvious  anachronism  to  can- 
vass the  frequency  of  this  crime,  and  the 
state  of  popular  opinion  in  regard  to  it,  in  a 
Christian  community.  Nevertheless,  the  fact  of 
the  existence  of  abortion  as  a  common  and  even 
increasing  evil,  appears  in  our  mortality  records  ; 
and  the  evidences  that  the  public  do  not  look 
upon  it  as  a  flagrant  crime,  and  regard  its  abet- 
tors as  criminals,  become  painfully  apjDarent 
when  the  horrible  developments  of  murder,  by 
the  imfamous  acts  of  abortionists,  are  revealed. 
The  proportion  of  still-births  to  the  living  gives 
the  only  basis  on  which  can  be  calculated  the 
number  of  cases  of  abortion.     These  figures  are, 


CKIME   OF   ABORTION.  209 

however,  but  approximative,  for  very  many  cases 
of  still-birth  are  not  produced  abortions,  while  a 
vast  number  obviously  escape  detection  and  reg- 
istration. Taking  our  mortality  reports  with  all 
due  allowance  for  these  discrepancies,  the  record 
is  still  sufficiently  humiliating.  From  these,  it 
appears,  that  since  the  first  registry  in  New  York, 
in  1805,  the  proportionate  and  actual  increase  of 
still-births  has  been  alarmingly  rapid.  In  1805, 
the  ratio  of  foetal  deaths  to  the  population  was 
1  to  1,633,  but  in  1849,  1  to  340.  In  1856,  the 
records  show  that  1  in  every  11  is  still-born  in 
this  city,  while  the  reports  of  European  coun- 
tries, even  allowing  for  criminal  abortions,  give 
the  proportion  of  still-births  at  1  in  15.  Accu- 
rate records  of  the  best  practitioners  give,  as 
the  ratio  of  premature  births,  or  non-viable  foe- 
tuses, to  the  whole  number  of  births,  which  in- 
cludes, of  course,  only  abortions  from  natural  or 
accidental  causes,  1  to  78  ;  but  in  New  York  the 
ratio  of  the  same  births  to  the  whole  number  is 
1  to  40.  The  ratio  of  premature  still-births  at  full 
time  in  this  city,  in  1846,  was  1  in  10,  and  in 
1856,  ten  years  later,  it  had  increased  to  1  in  4. 
In  1868-71,  it  appears  that  the  still-births  amount- 
ed to  upward  of  8  per  cent,  of  the  total  mortality- 
From  these  facts  it  is  apparent,  not  only  that 
produced  abortions  are  frequent  in  this  com- 
munity, but  that  they  are  rapidly  increasing. 
In  seven  years,  from  1850  to  1857,  the  still-births 
doubled,  and  we  have  good  evidence  that  since 


210  CRIME   OF  ABORTION. 

that  period  the  proportion  has  rapidly  increased. 
New  York  may  justly  be  taken  as  an  index  of 
this  country.  It  certainly  does  not  give  an  ex- 
aggerated representation.  The  registration  re- 
turns of  the  State  of  Massachusetts  show  that 
the  comparative  frequency  of  abortions  in  that 
State  is  thirteen  times  as  great  as  in  New  York 
city.  Allowing  that  some  discrepancy  in  the 
returns  must  exist,  they  still  prove  the  general 
prevalence  of  this  crime  in  one  of  the  most  in- 
telligent and  moral  communities  of  the  United 
States.  Whoever  examines  the  columns  of  coun- 
try papers,  and  marks  the  large  number  of  nos- 
trums which  in  various  and  cunning  phrases  are 
recommended  as  certain  to  effect  abortion,  can 
not  doubt  the  wide  and  almost  universal  preva- 
lence of  this  crime.  It  is  painful  to  believe  that 
the  public  conscience  is  not  alive  to  the  moral 
turpitude  of  abortion.  And  yet  we  have  fre- 
quent evidence  that  it  not  only  is  not  shocked  at 
the  criminality  of  the  act,  but  that  it  even  re- 
gards with  indifference  the  revelations  of  the 
scenes  of  cruelty,  debasement,  and  utter  loss  of 
every  virtuous  impulse  which  the  courts  often  re- 
veal to  the  public  gaze.  The  horrible  tale  of 
seduction,  abandonment,  suffering  and  death, 
now  so  frequently  brought  to  light  generally 
pass  without  a  comment.  On  the  contrary,  it 
is  to  be  feared  that  they  are  read  by  not  a  few  with 
as  much  interest  and  as  little  profit  as  the  idle 
tales  of  the  magazines.     It  can  not  be  denied 


CRIME   OF   ABORTION.  211 

that  ill  every  grade  of  society  lax  opinions  of  the 
criminality  of  procured  abortion  exists.  It  is 
not  alone  the  ignorant  and  vicious  that  consider 
it  no  crime ;  the  religious  equally  entertain  the 
belief  that  abortions  may  be  practiced  without  a 
shadow  of  guilt.  Every  physician  must  have 
been  approached  by  persons  of  upright  motives 
with  solicitations  to  prescribe  remedies  or  em- 
ploy means  which  would  terminate  an  early  preg- 
nancy. There  can  not  be  a  doubt  that  the  pub- 
lic mind  to-day  is  inclined  to  regard  abortion  as 
a  crime  only  under  certain  circumstances.  The 
life  that  is  sacrificed  is  regarded  as  unreal,  and 
the  convenience  or  comfort  of  the  parents  is 
alone  consulted.  Who  is  responsible  for  the 
tone  of  the  public  sentiment  on  the  question  of 
the  criminality  of  abortion  ?  We  believe  it  rests 
entirely  with  the  medical  profession.  Medical 
men  know  well  that  abortion  is  the  sacrifice  of 
human  life ;  they  know  well,  therefore,  the  hein- 
ousness  of  the  offense.  In  their  daily  inter- 
course with  their  patients  they  have  the  opportu- 
nity and  the  power  of  inculcating  correct  opin- 
ions of  the  nature  of  this  crime.  Every  truly 
conscientious  physician  performs  this  duty  faith- 
fully, and  often  most  effectually;  the  erring  and 
unthinking  are  instructed,  and  the  lesson  makes 
a  profound  and  lasting  impression.  But  there  is  a 
class  of  physicians  who  treat  this  subject  with  so 
much  indifference  that  they  sanction  rather  than 
discountenance  the  crime.     In  mild  terms  they 


212  CRIME   OF  ABORTION. 

object  to  employing  means  to  produce  abortion, 
and  yet  suggest  the  remedies  by  which  it  may 
be  accomplished.  The  effect  is  pernicious,  as 
the  crime  is  generally  perpetrated.  There  is  still 
another  class  of  medical  men,  standing  on 
the  boundary  between  legitimate  medicine  and 
quackery,  who  both  advocate  and  practice  abor- 
tion. They  assume  a  sanctimonious  air  and  a  cler- 
ical dress,  and  under  this  specious  guise  practice 
the  black  art  of  abortionists.  They  are  found 
in  the  most  respectable  medical  circles,  and 
make  their  professional  associations  subserve 
their  base  purposes.  Judged  by  the  moral  code 
of  a  Christian  civilization,  they  are  the  most 
abandoned  criminals  in  the  community,  and 
should  be  thoroughly  purged  from  the  profes- 
sion. City  and  country  Medical  Societies  should 
inquire,  "Have  we  not  abortionists  among  us?" 
We  do  not  doubt  that  they  will  be  found, 
and  that  too  in  startling  numbers,  especially  in 
large  cities.  The  whole  question  of  abortion, 
its  religious,  social,  and  professional  bearings, 
should  be  discussed  in  all  medical  societies.  The 
duties  of  our  profession  to  itself,  to  religion,  to 
the  cause  of  humanity,  should  be  established  on 
a  righteous  basis,  and  every  member  should 
be  compelled  to  conform  his  conduct  to  this 
standard.  The  sacred  obligations  which  the 
Father  of  Medicine  imposed  upon  his  followers, 
with  the  solemnity  of  an  oath,  are  as  binding  upon 
us  as  upon  the  graduates  of  the  school  of  Cos. 


XLI. 
EEVISION    OF    FEE-BILLS. 


IT  is  becoming  a  common  saying  that  "  every- 
thing is  rising  but  physicians'  fees."  The 
truth  of  this  remark  is  every  day  more  and  more 
painfully  evident.  Every  species  of  labor,  wheth- 
er mental  or  physical,  is  demanding  a  higher  and 
higher  premium,  and  every  kind  of  commodity 
is  rapidly  tending  to  higher  prices.  This  up- 
ward tendency  is  due  to  the  depreciation  of  the 
currency,  and  though  the  advance  of  wages  for 
service  is  fifty  per  centum,  there  is  only  a  simple 
equalization  of  values  when  the  income  from 
labor  and  the  outgo  for  living  are  balanced ; 
that  is,  though  the  laborer  now  receives  twofold 
prices  for  his  services,  and  has  to  pay  twofold 
prices  for  every  article  which  he  eats  or  wTears, 
he  does  not  improve  his  condition  by  demanding 
a  larger  salary,  but  merely  maintains  his  former 
position  in  spite  of  the  mutations  of  currency. 
The  artisan  who  lives,  as  it  is  said,  from  hand  to 
mouth,  feels  as  sensibly  the  first  fluctuations  of 
prices  as  the  thermometer  the  slightest  varia- 
tions of  temperature.  He  can  not  long  endure 
any  considerable  difference  between  income  and 
outgo,  and  therefore  demands  that  the  equili- 


214  REVISION   OF  FEE-BILLS. 

brium  be  restored.     Either  he  must  have  higher 
wages  or  the  materials  of  subsistence  must  fall 
to    their    former    standard.     But    while   labor 
promptly  adapts  the  values  of  its  services  to  the 
increased  cost  of  subsistence,  the  medical  pro- 
fession plods  on  undisturbed,  adhering  to  its  old 
fee-bills,  which  amount  now  in  fact  only  to  about 
one-third  the  former  rates.     We  hear  few  com- 
plaints among  practitioners,  though  every  one 
who  continues  to  charge  the  same  fee  as  for- 
merly, but  purchases  at  current  rates,  is  gradu- 
ally becoming  impoverished.     He  is  truly  living 
much  beyond  his  income,  and  will  finally  meet 
the  fate  of  all  "  fast  men."     If  his  rate  of  charges 
remain  the  same,  he  has  but  these  alternatives — 
either  he  must  have  a  corresponding  increase  of 
business,  or — bankruptcy.     It  is  not  difficult  to 
convince  any  medical  man  of  the  truth  of  these 
statements,  and  nearly  every  one  has  within  a 
few    years    come    by   degrees    to    realize   that 
they  are  decidedly  applicable  to  his  own  case. 
While  his  income  has  remained  the  same,  his 
necessary  expenditures  have  largely  increased. 
It  is  a  hopeful  sign  of  the  times  that  the  ques- 
tion of  self-protection  is  beginning  to  be  agitated 
in  our  profession  in  various  sections  of  the  coun- 
try.    In   some  localities  there  is  a  decided  ex- 
pression of  opinion  in  favor  of  raising  the  rate  of 
charges  for  professional  services.     In  one  or  two 
instances  medical  societies  have  exhibited  suffi- 
cient manliness  to  revise  their  fee-bill,  and  have 


REVISION  OF  FEE-BILLS.  215 

advanced  the  rate  in  a  liberal  manner.  It  is 
noticeable  that  this  subject  attracts  more  atten- 
tion in  the  newer  localities,  as  at  the  West,  than 
in  old  communities.  This  shows  a  more  prog- 
ressive and  independent  spirit  on  the  part  of  the 
younger  members  of  the  profession,  and  augurs 
well  for  the  future  character  of  the  practitioners 
of  the  new  States.  The  truth  is,  medical  men 
are  the  most  meagrely  paid  for  their  services  of 
any  class  of  any  community.  They  are  sup- 
posed to  be  liberally  educated,  and  yet  they  are 
called  upon  to  perform  the  most  menial  services. 
They  have  no  hours  of  positive  and  undisturbed 
relaxation  and  repose  either  night  or  day.  They 
have  no  independence  in  the  choice  of  patrons, 
but  must  run  at  the  call  of  the  meanest  as  well 
as  the  best,  the  poorest  as  well  as  the  richest. 
They  are  the  common  drudges  to  do  all  the  hard 
labor,  and  that  gratuitously,  of  every  charitable 
institution.  They  expose  themselves  freely  to 
every  form  of  contagion,  and  meet  death  on 
every  hand.  And  yet  the  reward  for  all  this  toil 
and  self-sacrifice  is  little  more  than  an  "  approv- 
ing conscience."  Medical  men  have  never  prop- 
erly estimated  the  importance  of  their  services. 
The  physician  who  places  a  high  estimate 
upon  his  professional  opinion,  and  never  gives  it 
without  ample  compensation,  makes  a  better  im- 
pression than  he  who  takes  small  fees.  Self- 
respect  and  self-appreciation,  inspire  respect  and 
and  confidence  in  others. 


XLII. 
CONFIDENTIAL    COMMUNICATIONS. 


THERE  lias  been  considerable  attention 
recently  given  to  the  question  of  the  re- 
sponsibilities of  physicians  in  the  communication 
of  medical  facts  of  a  confidential  nature.  The 
trial  of  a  practitioner  in  France,  guilty  of  betray- 
ing such  a  trust,  and  the  verdict  of  the  court 
against  him,  has  added  much  interest  to  the  dis- 
cussion. A  physician  of  great  respectability  re- 
cently has  been  subjected  to  persecution  by  a 
person  who  suspected  the  former  had  given  an 
opinion  unfavorable  to  his  character.  In  a 
second  instance  a  physician  was  importuned  by 
the  employers  of  his  patient  to  divulge  the  na- 
ture of  the  disease ;  and  on  evading  the  in- 
quiries, was  informed  that  they  had  examined 
his  prescriptions  in  the  hands  of  the  druggist, 
and  found  them  of  such  a  nature  as  to  cast  sus- 
picion on  his  patient.  A  writer  regards  the 
question  of  the  duties  of  practitioners,  under 
these  circumstances,  as  so  unsettled  that  it  is 
advisable  for  the  local  associations  to  "  vote  as  a 
body  that  they  will  not,  under  any  circumstances, 
impart  information  when  applied  to  in  private, 
concerning  any  patient,  in  answer  to  an  inquiry 


CONFIDENTIAL  COMMUNICATIONS.  217 

which  implies  suspicion  of  the  moral  character 
of  such  patient."  The  obligations  of  physician 
to  patient  in  matters  of  a  confidential  nature 
have  been  recognized  and  defined  both  by  our 
profession  and  by  writers  on  legal  medicine.  In 
this  country  the  profession  has  been  especially 
careful  to  establish  the  rule  of  conduct  in  such 
cases,  and  we  can  not  believe  that  any  well  edu- 
cated physician  has  any  doubt  as  to  the  nature 
of  his  duties.  Every  graduate  is  required  to 
subscribe,  either  in  language  or  form,  to  the  fa- 
mous code  of  professional  morals  embodied  in 
the  oath  of  Hippocrates,  which  contains  the  fol- 
lowing :  "  Whatever,  in  connection  with  my  pro- 
fessional practice,  or  not  in  connection  with  it,  I 
see  or  hear,  I  will  not  divulge,  as  reckoning  that 
all  such  should  be  kept  secret."  This  pledge 
has  been  incorporated  into  the  text  of  every  sys- 
tem of  medical  ethics  from  the  days  of  its  author 
to  the  present.  We  are  not,  however,  left  to 
this  ancient  inaugural  oath  for  guidance ;  but 
the  American  Medical  Association  has  defined 
explicitly  and  at  length  the  relations  of  physician 
to  patient.  No  American  physician  certainly 
needs  to  have  his  duties  in  confidential  cases 
more  clearly  set  forth.  In  Art.  II.,  sec.  2,  of  the 
Code  of  Medical  Ethics,  is  the  following : 

"  Secrecy  and  delicacy,  when  required  by  peculiar  cir- 
cumstances, should  be  strictly  observed ;  and  the  familiar 
and  confidential  intercourse  to  which  physicians  are  ad- 
mitted in  their  professional  visits,  should   be  used  with 
10 


218  CONFIDENTIAL  COMMUNICATIONS. 

discretion  and  with  the  most  scrupulous  regard  to  fidelity 
and  honor.  The  obligation  of  secrecy  extends  beyond  the 
period  of  professional  services ;  none  of  the  privacies  of 
personal  and  domestic  life,  no  infirmity  of  disposition  or 
flaw  of  character  observed  during  professional  attendance, 
should  ever  be  divulged  by  him  except  when  he  is  imper- 
atively required  to  do  so.  The  force  and  necessity  of  this 
obligation  are  indeed  so  great  that  professional  men  have, 
under  certain  circumstances,  been  protected  in  their  ob- 
servance of  secrecy  by  courts  of  justice." 

But  when  we  examine  as  to  the  medico-legal 
aspects  of  this  subject,  we  find  the  duties  of 
the  physician  are  changed.  If  it  is  necessary 
to  answer  the  demands  of  justice,  the  medical 
witness  is  required  by  the  common  law  to  divulge 
in  court  information  of  a  confidential  nature  ac- 
quired in  the  practice  of  his  profession.  Fon- 
blanque  says  :  "  When  the  ends  of  justice  abso- 
lutely require  the  disclosure,  there  is  no  doubt 
that  the  medical  witness  is  not  only  bound  but 
compellable  to  give  evidence,  ever  bearing  in 
mind  that  the  examination  should  not  be  carried 
further  than  may  be  relevant  to  the  point  in 
question."  In  a  celebrated  English  trial  it  was 
decided  "  that,  in  a  court  of  justice,  medical  men 
are  bound  to  divulge  these  secrets  when  required 
to  do  so."  But  on  that  occasion  the  presiding 
judge  made  the  following  pertinent  acknowledg- 
ment of  the  moral  obligations  of  the  physician  : 
"If  a  medical  man  was  voluntarily  to  reveal 
these  secrets,  to  be  sure  he  would  be  guilty  of  a 
breach  of  honor  and  of  great  indiscretion  ;  but 


CONFIDENTIAL   COMMUNICATIONS.  219 

to  give  that  information  which  by  the  law  of  the 
land  he  is  bound  to  do,  will  never  be  imputed  to 
him  as  any  indiscretion  whatever."  It  has  been 
contended,  indeed,  by  able  writers  that,  even  in 
a  court  of  law,  where  the  testimony  of  the  phy- 
sician is  important  to  meet  the  ends  of  justice,  he 
ought  not  to  be  obliged  to  divulge  confidential 
communications.  Belloc,  an  eminent  French 
authority,  says  :  "  The  tribunals  neither  ought, 
nor  have  the  power,  to  exact  from  a  physician 
the  revelation  of  a  secret  confided  to  him  in  con- 
sideration of  his  oflice ;  at  all  events,  he  may  and 
ought  to  refuse."  The  late  Prof.  Lee,  in  his  notes 
to  Guy's  Forsenic  Medicine,  takes  the  same 
ground.  He  says  :  "  We  believe  it  to  be  the 
moral  right  and  the  duty  of  medical  men  to  re- 
fuse to  disclose  in  a  court  of  justice  secrets  in- 
trusted to  them  in  professional  confidence,  and 
we  have  always  acted  on  such  belief.  If  phy- 
sicians become  the  repository  of  secrets,  under 
the  full  conviction,  on  the  part  of  society,  of  our 
moral  and  professional  obligations  to  hold  them 
sacred — secrets  which  otherwise  never  would 
have  been  revealed — who  can  believe  that  there 
is  any  earthly  power  which  ought  to  wring  them 
from  us,  or  which  can,  if  we  rightfully  understand 
our  privileges  and  duty  ?  If  private  confidence 
is  thus  to  be  broken  upon  every  imaginary  neces- 
sity, where  is  the  end  to  the  mischievous  conse- 
quences that  would  arise — especially  at  this  day, 
where   every   trial    is     published   to   the   world 


221  CONFIDENTIAL   COMMUNICATIONS. 

through  the  medium  of  the  public  prints?" 
Such  reasoning  has  had  its  influence  upon  legis- 
lative bodies  ;  and  in  some  States  the  statutes 
have  been  so  framed  as  to  prohibit  the  physician 
from  disclosing  confidential  communications. 
The  following  is  the  substance  of  this  rule  in 
New  York,  Missouri,  Wisconsin,  Iowa,  Indiana, 
and  Michigan  : 

"  No  person  duly  authorized  to  practice  physic  or  sur- 
gery shall  be  allowed  to  disclose  any  information  which  he 
may  have  acquired  in  attending  any  patient  in  a  profes- 
sional character,  and  which  information  was  necessary  to 
enable  him  to  prescribe  for  such  patient  as  a  physician,  or 
to  do  any  act  for  him  as  a  surgeon." 

In  whatever  light  we  view  this  subject,  the 
fact  is  constantly  prominent,  that  the  moral  obli- 
gation of  the  physician  to  retain  inviolate  all 
communications  of  a  confidential  nature  is  undis- 
puted. By  the  Hippocratic  oath  he  is  not  to  di- 
vulge what  he  sees  or  hears,  whether  in  connec- 
tion with  his  professional  practice  or  not.  The 
code  of  ethics  of  the  great  governing  body  of  this 
country  j3ledges  him  never  to  divulge  the  priva- 
cies of  personal  and  domestic  life,  nor  the  infirm- 
ities of  disposition,  nor  flaws  of  character  observed 
during  professional  attendance,  except  when  im- 
peratively required  to  do  so.  It  is  only  in  courts 
of  justice  that  the  seal  of  secrecy  can  be  broken, 
and  even  here  the  peculiar  moral  obligations  of 
the  physician  are  acknowledged  and  respected. 


XLIIL 
CIVIL  AND    MILITAKY   SURGEONS. 


PREVIOUSLY  to  the  late  war  the  medical 
profession  in  this  country  was  divided  into 
the  civil  and  military,  and  these  two  branches 
were  unfortunately  widely  separated.     This  es- 
trangement was  due  to  circumstances,  and  not 
to  prejudice  or  partisan  feeling.     The  graduate 
who  entered  the  army  was  of  necessity  immedi- 
ately withdrawn  from  the  circle  of  social  as  well 
as  professional  life,  and  assigned  to  duty  at  some 
remote  frontier  station  far  beyond  the  bounds  of 
civilization.     Here   he   was   detained   often   for 
years,  completely  shut  out  from  all  intercourse 
with  his  brethren,  and  thus  was  lost  to  the  pro- 
fession in  civil  life.     "Whoever  has  mingled  fa- 
miliarly with   civil  and  military  surgeons  must 
have    noticed    certain    marked    differences    be- 
tween them.     We  will  allude  to  the  two   most 
patent.     And,  first,  the  great  advantages  for  im- 
provement in  the  practical  duties  of  his  profes- 
sion, which  the  civil  surgeon  enjoys  in  contrast 
with  the  military,  necessarily  gives  the  former  a 
more  extensive  and  profound  knowledge  of  his 
art.     The  civil  surgeon  is  constantly  stimulated 
to  study  and  investigation,  and  is  called  upon 


222  CIVIL  AND   MILITARY   SURGEONS. 

hourly  to  apply  his  knowledge  practically.  He 
could  not  if  he  would  avoid  the  daily  lessons 
which  are  pressed  upon  his  attention.  He  lives 
in  an  atmosphere  charged  with  the  vitalizing  in- 
fluences of  professional  success,  and  if  he  fail, 
his  failure  is  due  to  his  own  incapacity  or  indo- 
lence. But  the  surgeon  who  enters  the  army  re- 
signs, at  the  very  threshold  of  his  career,  every 
hope,  and,  in  truth,  every  aspiration  for  future 
eminence  in  the  knowledge  of  the  science  and  art 
of  medicine.  He  is  at  once  removed  far  from  all 
the  facilities  for  scientific  investigation,  and  his 
sphere  of  observation  is  narrowed  to  the  smallest 
possible  circle.  He  forsakes  every  incentive  to 
study  and  every  association  for  improvement, 
and  consigns  himself  to  the  aimless  routine  of  a 
pioneer.  He  is  not  allowed  vacations  for  travel, 
observation,  and  study,  but  throughout  his  whole 
professional  life  remains  isolated  and  steadily 
confined  to  his  duties.  It  is  not  surprising  that, 
though  the  Army  Examining  Board  has  always 
selected  the  best  qualified  graduates,  the  scien- 
tific and  practical  character  of  the  Medical  Staff 
falls  considerably  below  that  of  the  profession  in 
civil  life.  If  now  we  compare  the  moral  tone  of 
the  two  classes  of  surgeons,  we  find  the  contrast 
equally  great,  but  quite  reversed.  The  average 
of  civil  practitioners  have  not  that  high  and 
unwavering  sense  of  the  dignity  of  their  call- 
ing which  characterizes  their  brethren  in  the  mili- 
tary   service      It   is    not    entirely   through   the 


CIVIL  AND   MILITARY    SURGEONS.  223 

ignorance  of  those  who  practice  it  that,  in  our 
day,  medicine  occupies  an  inferior  position; 
much  is  due  to  the  want  of  a  higher  moral  tone 
and  sentiment,  and  a  more  correct  apprecia- 
tion of  the  dignity  and  sacredness  of  the  phy- 
sician's duties.  Too  many  practice  their  art  as 
a  mere  trade,  and  comparatively  few  are  found 
willing  under  all  circumstances  to  defend  it 
against  the  machinations  of  charlatanry.  Social 
intercourse  and  the  power  of  gain  seem  gradually 
to  detract  from  its  honorable  character,  and  we 
find  it  too  often  prostituted  to  unworthy  pur- 
poses. But  when  we  turn  to  the  medical  staff  of 
the  regular  army,  as  formerly  constituted,  the 
change  is  as  marked  as  it  would  be  if  we  entered 
the  ranks  of  another  profession.  The  whole 
body  is  pervaded  by  a  common  sentiment  of 
loyalty  to,  and  even  veneration  for,  their  call- 
ing. Under  the  rigid  discipline  of  the  former 
chiefs,  who,  whatever  their  faults,  had  a  nice 
sense  of  honor,  and  compelled  all  who  came 
within  their  jurisdiction  to  appreciate  it,  there 
was  infused  into  the  whole  staff,  in  a  remarkable 
degree,  a  personal  dignity  and  a  regard  for  official 
and  professional  character.  All  the  represent- 
atives of  the  staff,  make  those  who  approach 
them  feel  that  they  are  in  the  presence  of  men 
who  hold  in  proper  esteem  their  official  position 
and  profession.  Indeed,  we  believe  that  in  the 
ranks  of  the  old  corps  of  the  regular  army  were  to 
be   found  the  best  representatives  of  the  true 


224  CIVIL  AND   MILITARY   SURGEONS. 

dignity  of  our  art.  The  whole  body  was  pene- 
trated with  a  regard  for  its  honor  and  worth  so 
profound  and  all-pervading  that  no  moral  delin- 
quencies could  be  tolerated.  Members  were  thus 
placed  under  an  obligation  to  sustain  the  high 
character  of  the  staff,  which  acted  as  a  most 
powerful  restraint  upon  their  conduct.  The  re- 
sult of  this  discipline  was  the  gradual  elevation 
of  the  character  of  the  surgeon,  until  he  occu- 
pied an  enviable  position  in  the  army.  The  medi- 
cal officer  was  everywhere  regarded  as  the  soul 
of  honor,  and  as  a  model  of  official  integrity. 
He  was  marked  as  a  gentleman  of  education  and 
refinement,  and  the  most  implicit  confidence  was 
reposed  in  him.  There  was  that  esprit  de  corps 
which  made  the  staff  a  unit  in  the  preservation 
of  its  dignity.  Whoever  seriously  offended  lost 
rank  and  position  even  in  his  own  estimation,  and 
sooner  or  later  concealed  his  shame  in  retirement 
from  the  army.  The  war  brought  about  a  re- 
markable commingling  of  the  two  sections  of  the 
medical  profession.  The  civil  practitioner  en- 
tered the  army,  and  the  army  surgeon  returned 
from  the  frontier  post.  The  two  branches  of  a 
common  stock  again  became  united,  and  it  is  a 
matter  of  no  small  interest  to  notice  how  favora- 
bly they  reacted  upon  each  other.  The  members 
of  the  regular  army  rapidly  advanced  in  a  knowl- 
edge of  the  science  and  art  of  surgery  ;  while  the 
civil  surgeon  became  animated  by  a  higher  senti- 
ment of  loyalty  to  his  profession. 


LXIV. 
NEW    SCHOOL    OF    OBSTETEICS. 


PEACTICAL  Surgery  is  evidently,  at  the  pres- 
ent time,  thoroughly  committed  to  conserv- 
atism. This  rule  of  practice  is  so  firmly  estab- 
lished, that  no  one  would  risk  his  reputation  by 
even  the  suspicion  that  he  did  not  fully  and 
heartily  assent  to  it.  The  same  may  be  said  of 
practical  medicine,  which,  long  since  adopted  ex- 
pectancy as  its  governing  principle,  and  all  rep- 
resentatives of  the  most  advanced  \iews  in  this 
branch  of  physic  accept  it  as  a  safe  if  not  a  uni- 
versal guide.  But  what  is  the  tendency  of  mod- 
ern obstetric  medicine?  Time  was  when  the 
ruling  motto  among  accoucheurs  ran  thus,  "  med- 
dlesome midwifery  is  bad."  So  earnestly  was 
this  idea  inculcated  by  obstetrical  professors, 
that  if  a  graduate  forgot  everything  else,  this 
terse  sentence  rang  in  his  ears  every  time  he 
approached  the  lying-in  chamber.  Many  will  re- 
member during  their  natural  lives  the  vehemence 
with  which  an  eccentric  professor,  twenty  years 
ago,  denounced  the  forceps,  and,  incidentally,  in 
language  not  less  severe,  the  practitioner  who 
would  use  them.  Language  failing  to  give  full 
expression  to  his  contempt  of  obstetrical  opera- 

10* 


226  NEW   SCHOOL   OF   OBSTETRICS. 

tions,  he  illustrated  his  meaning  by  grimaces  and 
a  variety  of  grotesque  manipulations  of  his  per- 
son which  served  to  fix  in  the  mind  of  the  terri- 
fied student  the  truth  that  meddlesome  mid- 
wifery must  be  bad.  Such  teachings  bore  their 
legitimate  fruits.  Operative  interference  in  ob- 
stetric practice  was  a  res3rt  to  which  each  prac- 
titioner was  brought  only  after  every  prudent 
mean  was  exhausted,  and  the  condition  of  the 
patient  imperatively  demanded  assistance.  The 
frequent  employment  of  artificial  aid  in  mid- 
wifery practice  was  an  opprobrium  under  which 
no  accoucheur  would  willingly  rest.  It  was  the 
pride  of  practitioners  to  report  the  number  of 
cases  which  they  attended  annually  without  the 
use  of  forceps.  Several  of  the  oldest  and  most 
eminent  obstetricians  of  this  country  can  boast 
that  they  never  had  occasion  to  use  the  forceps 
more  than  once,  twice,  or  thrice  in  their  own 
practice ;  nor  did  they  have  a  considerable  an- 
nual mortality  among  their  cases.  Their  records 
of  practice,  on  the  contrary,  exhibit  a  percent- 
age of  deaths  too  slight  for  criticism.  But  who- 
ever is  familiar  with  current  medical  literature 
must  have  become  convinced  that  a  new  and 
powerful  school  of  obstetrical  practitioners  and 
teachers  is  rising  into  importance,  which  has  for 
its  chief  aim  to  popularize  operative  midwifery. 
With  them  the  old  text,  "  meddlesome  midwifery 
is  bad,"  passes  for  a  prejudice  of  our  forefathers. 
Brushing  it  away  as  the  rubbish  of   the  past, 


NEW   SCHOOL   OF   OBSTETEICS.  227 

they  have  laid  as  a  foundation  for  the  super- 
structure which  they  are  building,  the  power  and 
necessity  of  art  to  guide  to  successful  issue  the 
processes  of  nature.  While  science  is  leading 
physicians  and  surgeons  to  conservatism,  its 
teachings  have  a  contrary  influence  upon  obstet- 
ricians. As  the  armamtarium  chirurgicum  di- 
minishes, the  armamentarium  obstetricum  in- 
creases. Twenty  years  ago  few  practitioners 
had  obstetrical  instruments,  and  these  were 
carefully  concealed ;  to-day  they  are  a  neces- 
sary part  of  the  graduate's  outfit,  and  occupy 
too  frequently  a  conspicuous  place  in  his  office. 
The  change  in  obstetrical  practice  which  we 
have  indicated  as  now  in  progress  must  be 
witnessed  with  alarm  by  every  believer  in  con- 
servatism in  medicine.  Already  we  witness 
the  sad  results  which  must  inevitably  follow  the 
inculcation  of  an  aggressive  practice  in  mid- 
wifery. Many  lying-in  asylums  give  a  far  larger 
mortality  of  puerperal  cases  and  of  still-births 
at  full  term  than  formerly ;  and  the  history  of 
these  institutions  shows  that  the  number  of  in- 
strumental cases  is  annually  largely  increasing. 
Private  practice  would,  if  honestly  written,  give 
similar  results.  The  medical  journals  teem  with 
the  death-records  of  meddlesome  midwifery ; 
and  it  is  surprising  what  senseless  audacity  is 
frequently  exhibited  by  these  progressive  obstet- 
ricians in  publishing  to  the  world  the  records  of 
their  own  shame.     It  was  not  Ions  since  that  a 


228  NEW   SCHOOL   OF   OBSTETRICS. 

practitioner  of  this  school  gravely  advocated  ver- 
sion in  natural  labor,  and  reported  a  large  number 
of  cases  in  proof  of  its  advantages,  in  several  of 
which  the  arm  or  leg  was  fractured  during  the  nec- 
essary manipulations.  It  would  seem  quite  impos- 
sible that  a  school  of  practice,  founded  on  such 
erroneous  principles,  and  giving  such  disastrous 
results,  could  ever  make  proselytes.  It  requires, 
however,  but  a  slight  knowledge  of  human  na- 
ture and  the  peculiar  temperament  of  the  pres- 
ent age,  to  discover  that  such  a  code  of  prac- 
tice has  many  elements  of  popularity.  The 
£clat  of  an  operation  is  never  lost  sight  of  by 
the  ambitious.  If  the  license  is  given  they  will 
never  fail  to  find  the  opportunity  to  impress  the 
community  with  their  skill  and  daring.  The 
tedious  waiting  at  the  bedside  may  also  be  lim- 
ited by  interference,  and  the  practitioner  is  liable 
to  consult  his  convenience  rather  than  the  inter- 
ests of  the  patient.  In  the  earnest  and  eloquent 
words  of  a  recent  author,  "  it  is  time  that  plain 
language  should  be  spoken  on  this  subject :  the 
spirit  of  conservative  midwifery  seems  to  have 
been  lost  in  sleep  ;  the  ordinances  of  nature  have 
been  disregarded,  and  the  accoucheur  with  in- 
strument in  hand,  rampant  in  his  desire  for  op- 
portunity, rushes  with  good  heart  and  unmeas- 
ured confidence  to  what  he  deems  the  scene  of 
conquest,  but  too  often,  alas !  it  proves  a  scene 
of   harrowing  agony  to  the  unhappy  patient." 


XLV. 
SPECIALISTS     IN    MEDICINE. 


THE  tendency  of  the  age  is  to  the  division  of 
labor.  We  see  it  in  all  the  mechanic  arts 
and  in  every  department  of  human  service  and 
thought.  It  grows  out  of  the  limited  capacity 
of  both  the  body  and  mind,  and  the  constant  ex- 
pansion of  every  branch  of  science  and  of  every 
department  of  industry.  Not  all  minds  can 
grasp  the  widely  varying  facts  in  any  one  of 
the  generally  recognized  divisions  of  the  sci- 
ences, much  less  become  profoundly  conversant 
with  them.  Neither  can  the  artisan  become  pro- 
ficient in  many  branches  of  the  same  business. 
He  who  is  recognized  as  a  "  Jack  at  all  trades  " 
cannot  excel  in  any  one  art,  though  he  may  be  a 
most  useful  person  by  his  general  knowledge. 
Medicine,  as  a  science  and  an  art,  has  not 
escaped  this  tendency  to  the  division  of  labor. 
The  three  grand  divisions,  practical  medicine, 
surgery,  and  obstetrics,  have  long  been  recog- 
nized and  adopted.  They  \ery  naturally  grow 
out  of  fundamental  differences  in  methods  of 
treatment  of  diseases.  Surgical  affections  re- 
quire, for  the  most  part,  entirely  different  reme- 
dial agents  from  medical  diseases ;  and  the  prae- 


230  SPECIALISTS   IN   MEDICINE. 

tice  of  obstetrics  differs  equally  from  both  in  the 
appliances  of  art.  In  the  progress  of  the  medi- 
cal sciences  many  of  the  classes  of  maladies  em- 
braced in  these  several  grand  divisions  have 
become  objects  of  special  study,  as  the  diseases 
of  the  eye  and  ear  in  surgery,  of  the  heart  and 
lungs  in  medicine,  and  of  the  uterus  in  obstet- 
rics. These  divisions  have  gradually  become 
more  and  more  numerous,  until  surgery,  medi- 
cine, and  obstetrics  are  little  else  than  an  ag- 
glomeration of  specialties.  The  necessity  of 
pursuing  the  study  and  practice  of  a  single 
branch  in  order  to  success,  is  beginning  to 
possess  the  minds  of  young  physicians.  They 
are  stimulated  by  the  examples  of  men  who  have 
won  reputation  and  fortune  by  devotion  to  a 
specialty.  It  is  time  that  this  subject  was  thor- 
oughly discussed  in  all  its  bearings,  that  the 
younger  members  of  the  profession  may  have 
correct  views  of  the  advantages  or  disadvan- 
tages of  such  a  course.  The  arguments  gene- 
erally  brought  forward  by  the  advocates  of  spe- 
cialties in  medicine  are,  as  we  have  already  in- 
timated, those  which  apply  to  a  division  of 
labor  in  any  other  department  of  business.  And 
they  have  great  plausibility.  To  surpass  all  con- 
temporary laborers  in  any  single  pursuit  re- 
quires the  undivided  efforts  of  every  ordinary 
mind.  But  we  are  not  prepared  to  accept  this 
reasoning  in  an  unqualified  sense.  As  a  general 
rule  we  must  aver  that  the  man  whose  knowledge 


SPECIALISTS   IN    MEDICINE.  231 

in  business  takes  the  widest  range  lias  the  best 
basis  for  success.  This  fact  is  eminently  true  in 
medicine.  The  general  surgeon,  physician,  or 
obstetrician,  will  prove  a  better  practitioner  in 
any  particular  disease  than  the  specialist.  The 
most  successful  surgeon  is  the  man  who  has  also 
a  thorough  knowledge  of  practical  medicine. 
The  relations  of  diseases  are  intimate,  often  ob- 
scure, and  frequently  all-controlling.  The  prac- 
titioner who  fails  to  detect  these  relations  will 
certainly  not  be  thoroughly  qualified,  whatever 
may  be  his  pecuniary  success.  He  will  treat  dis- 
eases in  his  specialty  from  the  most  narrow 
stand-point,  and  too  frequently  fail  to  compre- 
hend those  remote  influences  and  widely  extended 
sympathies  which  most  seriously  modify  their 
progress.  These  peculiarities  the  general  prac- 
titioner anticipates  and  readily  recognizes,  and 
promptly  meets  every  manifestation  with  proper 
remedies.  It  has  been  remarked  by  an  accurate 
observer  of  the  progressive  changes  in  the  med- 
ical profession,  that  the  older  physicians  often 
much  excel  the  younger  in  methods  of  treat- 
ment, because  they  take  a  much  wider  range  of 
symptoms,  and  do  not  narrow  their  view  to 
single  organs  and  individual  diseases.  There  is 
much  truth  in  the  remark.  The  recent  graduate 
has  his  mind  pre-occupied  with  scholastic  divis- 
ions and  subdivisions  of  diseases  of  individual 
parts,  and  in  his  analysis  he  becomes  more  and 
more  restricted,  until  the  attention  is  fixed  upon  a 


232  SPECIALISTS   IN   MEDICINE. 

limited,  perhaps  an  insignificant  part  of  the  sub- 
ject under  investigation.  The  same  is  true  of  the 
pure  specialist,  as  the  term  is  now  employed.  In 
general,  he  is  necessarily  a  poor  practitioner, 
and  though  he  may  more  correctly  interpret  the 
purport  of  pathological  changes  than  others  who 
have  studied  the  special  forms  of  disease  less 
minutely,  he  will  show  but  little  skill  in  employ- 
ing remedies.  If  we  contrast  also  the  usefulness 
and  the  rank  in  the  profession  of  the  general 
practitioner  with  that  of  the  specialist,  we  shall 
see  clearly  that  the  studies  of  the  former  tend 
much  more  to  enlarge  the  mind,  to  strengthen 
its  grasp,  and  increase  its  powers  of  correct 
analysis.  Every  force  acting  upon  or  within  the 
human  organism  is  investigated,  and  its  near  or 
remote  influence  carefully  weighed  or  measured. 
It  is  a  matter  of  historical  record  that  the  great 
practical  men  of  the  profession,  in  all  times,  have 
been  students  of  medicine,  in  the  largest  sense  ; 
they  have  embraced  within  the  scope  of  their 
studies  the  circle  of  its  sciences,  and  have  made 
each  department  contribute  to  their  success. 
Hunter,  Abernethy,  Brodie,  Simpson,  Hcsack, 
Mott,  Warren,  are  a  few  of  the  recent  names 
which  occur  to  us  as  examples  of  that  large  and 
liberal  culture,  which  embraced  the  widest  field 
of  scientific  research,  and  subsidized  every  avail- 
able fact.  They  limited  their  specialties  in  prac- 
tice to  the  three  grand  natural  divisions,  viz.  : 
Medicine,  Surgery,  Obstetrics. 


XL  VI. 
GRATUITOUS    SERVICES. 


THE  medical  profession  has  the  reputation, 
at  least  among  its  own  members,  of  being 
greatly  overworked  and  miserably  underpaid.    It 
is  true,  even  of  those  services  for  which  medical 
men  are  promptly  and  fully  paid,  that  the  phy- 
sician receives  a  smaller  compensation  than  any 
person  who  brings  to   the   discharge   of    duties 
special  knowledge  ;  he  ranks  below  many  classes 
of  artisans.      And  we   must   add  the   fact   that 
much  of  the  time  his  services  are  confessedly 
rendered    gratuitously.     All    the    poor    are   his 
patrons,  and  by  far  the  most  exacting  patrons 
that   he   can   claim.     Their   demands   upon   his 
time  are  constant,  and  their  calls  are  always  im- 
perative.    Finally,  if  there  is  a  public  institution 
which  requires  a  medical  attendant,  this  service 
must  also  be  gratuitous,  though  the  governors  or 
commissioners   who    control   its   affairs    receive 
large  salaries.     It  is  not  our  intention  now  to 
pass  in  review  the  instances  of  extortion  practiced 
upon  our  profession,  but  to  notice  one  in  partic- 
ular where  reform  is  needed,  and  which  medical 
men   should    unite   to   obtain.     Life   Insurance 
Companies  are  wealthy  organizations  which  re- 


234  GRATUITOUS   SERVICES. 

ceive  large  incomes  from  their  business.  Many 
of  these  corporations  have  amassed  immense 
wealth,  and  all  are  in  a  greater  or  less  degree 
prosperous.  These  societies  are  actually  depend- 
ent upon  medical  officers  for  protection  and 
success.  The  medical  examiner  is  indeed  the 
most  important  officer  in  the  organization,  for  the 
prosecution  of  the  business  calls  for  his  daily 
examination  of  applicants.  The  success  of  the 
whole  business  of  Life  Insurance  may  be  said  to 
rest  most  unequivocally  upon  the  professional 
knowledge  of  the  medical  examiners.  No  Life 
Insurance  Company  would  for  a  moment  employ 
a  medical  officer  of  recognized  incompetency.  On 
the  contrary,  every  such  association  seeks  out 
the  best  educated  and  most  reputable  physician 
for  this  office,  and  to  his  professional  knowledge 
intrusts  its  future  success.  Here  is  a  marked 
instance  in  which  the  prominent  medical  men 
of  any  given  community  are  placed  in  a  po- 
sition to  command  full  and  ample  remuneration 
for  their  services.  Their  patrons  are  wealthy 
and  powerful,  and  bestow  large  salaries  on  other 
important  officers.  The  medical  examiner  ranks 
among  the  first  in  point  of  real  consequence,  and 
brings  to  the  discharge  of  his  duties  a  higher 
qualification  than  any  other  officer,  viz.  the 
education  of  a  scientific  expert.  Such  services 
in  every  other  department  of  business  command 
respect  and  the  most  liberal  reward.  Why  do 
they  not  in  a  Life  Insurance  Company  ?    There  is 


GRATUITOUS   SERVICES.  235 

but  one  reason,  and  that  is  apparent  on  the  most 
superficial  examination  of  the  subject.  It  is 
that  medical  men  do  not  place  a  proper  esti- 
mate upon  their  own  services.  There  are  found 
in  this  and  every  community  physicians  in 
large  practice  taking  high  rank  in  their  profes- 
sion, who  are  willing  to  travel  several  miles  at 
mid-day  to  attend  at  the  offices  of  Life  Insur- 
ances, and,  after  making  as  critical  medical  ex- 
aminations as  would  be  required  in  most  obscure 
diseases,  they  accept  with  gratitude  the  paltry 
fee  of  three,  two,  or  even  one  dollar  per  head. 
Indeed,  the  passion  for  serving  these  great  mo- 
nopolies almost  gratuitously,  is  so  strong  among 
our  leading  physicians,  that  they  struggle  for 
the  vacancies  which  occur  with  all  the  despera- 
tion of  politicians.  Instead  of  rejecting  with 
scorn  the  miserable  pittance  which  these  com- 
panies dole  out  to  them  in  the  way  of  fees,  they 
pocket  it  with  an  air  of  the  most  intense  satis- 
faction. "We  might  forgive  such  greed  in  a 
young  man  who  has  to  struggle  hard  to  obtain  a 
livelihood ;  but  in  older  members,  enjoying  suf- 
ficient incomes  from  their  legitimate  business,  it 
is  reprehensible  and  unpardonable.  A  great 
reform  is  needed  in  this  matter.  The  profession 
should  unite  in  requiring  that  every  medical  ex- 
aminer in  a  Life  Insurance  Company  shall  de- 
mand an  adequate  payment  for  his  services.  In- 
stead of  three  dollars  for  each  examination  let 
him  require  seven  or  ten  dollars,  or  still  better 


236  GRATUITOUS   SERVICES. 

twelve,  as  in  English  companies.  In  this  engage- 
ment he  has  the  power  of  compulsion,  for  no 
Life  Insurance  Association  will  exchange  a  re- 
putable physician  for  one  of  even  doubtful  char- 
acter. There  can  then  be  no  reasonable  excuse 
for  this  humiliation  of  the  profession  at  the 
hands  of  the  older  members.  There  is,  however, 
still  another  method  in  which  the  profession  are 
induced  to  serve  these  wealthy  corporations, 
and  in  this  instance  they  render  their  services 
gratuitously.  To  insure  itself  against  all  possi- 
ble risks  the  Association  requires  the  applicant 
to  obtain  from  his  regular  medical  attendant  a 
lengthy  certificate  as  to  his  predisposition  to  dis- 
ease, etc.,  etc.  This  certificate  is  generally  made 
out  by  the  physician  as  a  favor  to  his  patient, 
when  in  reality  it  is  a  gratuitous  service  rendered 
to  the  insuring  company.  They  require  it  as 
an  additional  safeguard.  The  physician  acts  the 
part  of  a  consultant,  and  receives  nothing  for 
his  trouble  and  information.  View  this  act  in 
whatever  light  we  may  it  can  but  be  regarded  as 
a  gross  imposition  upon  the  profession,  and 
should  be  resolutely  resisted.  The  medical  at- 
tendant of  the  applicant  is  entitled  to  his  fee  as 
a  consulting  physician,  and  should  demand  it 
without  reserve.  In  this  case,  also,  he  has  the 
power  to  demand  that  justice  be  done  him,  and 
to  compel  the  performance  of  the  act.  His  infor- 
mation is  absolutely  essential  to  the  complete 
medical   examination   of  the    insured,    and   the 


GRATUITOUS  SERVICES.  237 

Company  will  not  proceed  without  it.  The  duty  of 
the  profession  seems  to  us  apparent.  By  concert 
of  action  individual  members  engaged  in  Life  In- 
surance Companies  should  demand  an  adequate 
remuneration  for  their  services.  The  question  is 
not  whether  A  or  B  can  afford  to  leave  his  busi- 
ness, and  attend  at  the  office  of  the  Company  an 
hour  or  two  daily  for  three  or  five  dollars ;  it  is 
rather  a  question  which  concerns  the  honor  and 
dignity  of  the  whole  profession,  and  which  no  in- 
dividual has  the  right  to  settle  according  to  his 
own  necessities.  In  this  matter  he  is  bound  to 
consult  the  interests  of  his  calling,  and  this  call- 
ing demands  of  every  member  that  he  sustain  in 
his  own  person  its  claims  as  an  exalted  scientific 
pursuit.  It  is  equally  clear  that  every  physician 
should  positively  refuse  to  make  out  a  certificate 
for  insurance  for  his  patient  unless  he  is  paid  by 
the  Company  a  full  consultation  fee.  By  de- 
clining this  gratuitous  service  he  does  no  violence 
to  his  relations  with  his  patient,  and  will  demand 
only  what  is  just  and  right.  If  the  profession 
will  unite,  these  most  desirable  objects  can 
readily  be  obtained.  In  England  a  noble  stand 
has  been  made  against  the  system  of  gratuitous 
services  to  these  monopolies,  and  the  result  has 
been  most  favorable ;  after  a  feeble  resistance, 
the  value  of  the  services  of  physicians  to  the 
success  of  the  business  of  insurance  was  con- 
ceded by  the  allowance  of  ample  remuneration 
to  every  one  who  serves  them. 


XLVII. 
ALLEGED    CRIMINALS. 


I^HE  frequent  instances  of  attempts  at  suicide 
by  persons  detained  in  confinement  de- 
serves serious  consideration.  These  occurrences 
would  not  be  worthy  of  remark  if  they  were  lim- 
ited to  prisoners  awaiting  the  execution  of  the 
death-penalty,  or  even  condemned  to  a  long  pe- 
riod of  imprisonment.  We  should  then  have  an 
adequate  cause  for  the  attempted  self-destruction, 
for  in  all  periods  of  history,  criminals  have  been 
guilty  of  this  crime.  But  in  this  instance  the 
crime  is  more  frequently  attempted  by  quite 
another  class  of  prisoners  :  they  are  those  per- 
sons who  are  awaiting  their  trial,  and  who  have 
been  charged  with  grave  offences.  In  nearly  every 
case  the  victim  of  self-destruction  has  left  behind 
him  an  explanation  of  his  last  criminal  act.  The 
exciting  cause,  if  it  may  be  so  designated,  is  con- 
finement in  the  dreary,  noisome  cells  of  prisons. 
No  sane  person  can  be  taken  from  the  fresh  air 
and  sunlight,  and  be  immured  in  these  gloomy 
recesses,  more  dreary  than  the  niches  of  a  cata- 
comb, for  any  considerable  period,  without  com- 
ing to  prefer  death  to  life.  Shut  out  from  even 
a  ray  of  sunlight,  stifled  by  the  dead  and  fetid 


ALLEGED   CRIMINALS.  239 

atmosphere  of  a  living  tomb,  permitted  no  other 
liberty  than  to  pace  the  length  of  his  own  body, 
the  mind  of  the  prisoner  gradually  loses  its  sus- 
ceptibilities ;  the  past  with  its  pleasant  memories 
aggravates  the  miseries  of  the  passing  hour,  and 
the  future  takes  coloring  from  the  gloom  and 
melancholy  of  the  present.  He  implores  to  be 
put  on  trial,  and  either  by  acquittal  or  condem- 
nation be  relieved  from  the  horrors  of  a  living 
death.  But  courts  do  not  hear  his  petition,  and 
his  case  is  adjourned  for  long  weary  months. 
Meanwhile  the  prisoner  is  gradually  approach- 
ing suicidal  mania  or  melancholy,  and  suddenly, 
and  often  unexpectedly,  he  takes  the  fatal  step. 
As  yet  his  guilt  or  innocence  is  unproven.  This 
violent  termination  of  his  life  is,  however,  in  the 
public  estimation,  sufficient  evidence  of  his  guilt- 
iness, and  upon  the  poor  man's  memory  is 
stamped  the  ineffaceable  stigma  of  crime.  It  is 
a  well  established  maxim  of  criminal  law,  that 
the  accused  shall  be  regarded  as  innocent  until 
he  is  proven  to  be  guilty.  In  this  recorded  de- 
cision of  our  courts  we  have  a  beautiful  illustra- 
tion of  justice  leaning  to  the  side  of  mercy.  For, 
the  mere  arrest  of  a  person  charged  with  the 
commission  of  crime  might  be  taken  as  pre- 
sumptive evidence  of  his  guilt ;  and  for  the  gen- 
eral good,  as  well  as  protection  of  society,  he 
might,  with  the  greatest  propriety,  have  been 
treated  as  a  criminal  until  proven  to  be  innocent, 
But  mercy  has  so  far  tempered  the  decrees  of 


240  ALLEGED   CRIMINALS. 

justice  that  the  humanitarian  view  has  been  uni- 
versally adopted,  and  the  accused  stands  before 
the  court  an  innocent  person  until  proven  to  be 
guilty.  It  would  seem  to  follow,  as  a  natural 
sequence  from  this  maxim,  that  persons  arrested 
for  crimes  should  be  treated  as  if  innocent ;  that 
they  should  be  placed  under  such  restraints,  or 
bonds,  as  will  simply  insure  their  appearance  in 
courts,  and  that  they  be  not  otherwise  deprived 
of  their  liberty.  It  is  but  right  that  a  person  who 
is  believed  to  be  innocent,  and  who  in  the  eye  of 
the  law  is  innocent,  should  have  all  the  privileges 
of  one  who  is  innocent.  There  would  seem  to  be 
a  manifest  injustice  in  removing  such  persons 
from  their  ordinary  duties,  and  much  more  in 
subjecting  them  to  confinement.  It  might  with 
great  propriety  be  added,  that  the  citizen  who 
allows  himself  to  be  accused  of  crime,  and  to  be 
put  on  trial,  yields  sufficiently  to  the  necessities 
of  society  without  being  subjected  to  any  further 
humiliation  until  he  is  proved  to  be  guilty.  But 
practically  the  law  reverses  its  own  wise  and  hu- 
mane maxim.  It  not  only  demands  the  arrest  of 
the  accused  but  condemns  him,  before  trial,  to  a 
felon's  or  a  murderer's  cell.  In  close  and  soli- 
tary confinement,  deprived  of  every  social,  do- 
mestic, and  political  privilege,  he  remains  for 
months,  and  often  for  years,  before  the  ques- 
tion of  guilt  is  determined.  Our  criminal  juris- 
prudence should  be  radically  changed.  Either 
the  accused  should  be  immediately  put  on  trial 


ALLEGED   CRIMINALS.  241 

as  soon  as  the  necessary  evidence  is  obtained, 
or  he   should  be    held   to    appear  by  suitable 
bonds.     If  restraint   is  absolutely  necessary  to 
insure  that  appearance  in  case  of  cajjital  offences, 
provision   should   be   made  for    his   comfort  in 
keeping  with  the  spirit  of  the  law,  which  as  yet 
regards  him   as  innocent   of  the  alleged  crime. 
He  should  have   all  the   privileges   compatible 
with  simple  detention.     His  room  should  not  be 
a  cell,  but  a  cheerful,  well-aired  and  sunlighted 
apartment,   furnished   with   comforts   and   con- 
veniences such  as  the  individual  can  command 
when    at  liberty;    he   should    no   longer  have 
meagre   and   unwholesome   prison   fare,  but  be 
provided  with  a  liberal  and  healthful  diet ;  his 
freedom  for  exercise  in  the  open  air  should  be 
ample  ;  and  books  and  papers,  and  other  means 
of  mental  recreation  should  be  freely  supplied. 
Aud  it  is  quite  as  important  that  his  companion- 
ship should   be   carefully  selected.     Not  unfre- 
queutly  the  alledged  criminal  is  of  pure  mind, 
but    by  hourly   contact   with    the   impure   and 
vicious    he   gradually   sinks   to   their   level,  es- 
pecially if  he  is   young   and   susceptible.     We 
learn  from  the  prison  records  that  many  of  the 
most  daring  offenders  took  their  first  lessons  in 
the  methods  of  perpetrating  crime  in  the  jails  in 
which  they  were  lodged  previous  to  their  first 
trial.     Thus  the  State  not  only  inflicts  a  great 
wrong  upon  the  individual,  but  too  frequently,  con- 
verts an  innocent  citizen  into  an  expert  criminal. 
11 


XLVIII. 
MODERN    MILITARY    SCIENCE. 


AMBROSE  PARE,  the  famous  Cliirurgeon 
to\  three  consecutive  Kings  of  France, 
writing,  now  nearly  three  hundred  years  ago,  "  of 
wounds  made  by  gun  shot,  other  fiery  engines, 
and  all  sorts  of  weapons,"  contrasted  the  fire- 
arms of  his  time  with  the  warlike  weapons  of  the 
ancients,  and  says  of  the  latter,  "  they  seem  to 
me  certain  childish  sports  and  games  made  only 
in  imitation  of  the  former."  So  impressed  was 
he  with  the  destructive  power  of  the  "  fiery  en- 
gines" of  war  in  use  that  he  pronounced  the  fol- 
lowing opinion  upon  the  inventor  of  the  gun  :  "  I 
think  the  deviser  of  thi  j  deadly  engine  hath  this 
for  his  recompence,  that  his  name  should  be  hid- 
den by  the  darkness  of  perpetual  ignorance,  as 
not  meriting  for  this,  his  most  pernicious  inven- 
tion, any  mention  from  posterity."  The  only 
comparison  which  he  could  make  of  the  effects  of 
"  this  hellish  engine"  (a  cannon)  "  is  with  thunder 
and  lightning ;"  greatly,  however,  at  the  expense 
of  the  latter.  He  says  :  "  For  what  in  the  world 
is  thought  more  horrid  or  fearful  than  thunder  and 
lightning  ?  and  yet  the  hurtfulness  of  thunder  is 
almost  nothing  to  the  cruelty  of  these  infernal 


MODEEN  MILITAKY  SCIENCE.  243 

engines."  Had  the  pious  Huguenot  surgeon 
foreseen  how  these  "infernal  engines"  and 
"  magazines  of  cruelty,"  as  he  calls  them,  would 
multiply  in  after  ages,  and  be  rendered  infinitely 
more  destructive  of  human  life,  we  may  well  be- 
lieve that  he  would  have  added  fearful  maledic- 
tions to  his  condemnation  of  their  inventor.  But 
if  a  collection  of  the  "  fiery  engines,  and  all  sorts 
of  weapons"  of  the  sixteenth  century  were  to  be 
exhibited  in  our  day,  it  would  be  the  object  of 
universal  merriment.  The  formidable  weapons 
which  struck  them  with  consternation  would  be 
regarded  as  little  better  than  children's  play- 
things compared  with  the  instruments  of  warfare 
which  are  now  brought  into  the  field.  The  im- 
provements in  the  various  enginery  of  war  are 
indeed  marvelous  in  our  time ;  even  if  we  com- 
pare it  with  that  of  a  half  or  a  quarter  of  a  cen- 
tury since.  It  is  seen,  not  only  in  the  compara- 
tively greater  precision  of  firearms,  at  greater 
distances,  but  in  the  destructive  character  of  the 
missiles  projected.  A  favorite  order  in  the  war 
of  the  revolution,  when  the  old  flint-lock  musket 
was  the  weapon  in  the  hands  of  the  common 
■  soldier,  was,  "  hold  fire  until  you  see  the  white  of 
the  enemy's  eye."  Even  ten  years  ago  the  mus- 
ket balls  would  not  strike  the  object  at  eighty 
yards,  and  hence  the  few  wounds  which  often 
followed  a  discharge  of  musketry,  at  the  dis- 
tances at  which  opposing  forces  generally  meet. 
In  Caffraria  80,000  rounds  of  ball-cartridges  fired 


244  MODERN  MILITARY   SCIENCE. 

from  the  old  musket  wounded  but  twenty-five 
Caffres ;  and  at  the  battle  of  Salamanca  but  one 
ball  in  3,000  took  effect.  Contrast  these  results 
with  the  rifle,  which  is  now  principally  in  the 
hands  of  our  soldiers.  The  Enfield  rifle  is  sighted 
at  1,000  yards,  and  two-thirds  of  the  shots  of  a 
company  of  infantry  have  been  known  to  take 
effect  upon  an  attacking  body  of  cavalry.  The 
contrast  in  the  precision  of  recent  firearms  with 
those  in  use  in  the  early  part  of  this  century  is 
strikingly  exhibited  in  the  following :  At  the 
actions  in  Flanders  on  the  16th,  17th,  and  18th 
of  June,  1815,  including  the  battles  of  Quatre 
Bras  and  Waterloo,  the  number  of  wounded  in 
the  British  army  was  about  8,000.  The  armies 
approached  within  1,200  yards  of  each  other,  and 
were  for  the  most  part  out  of  reach  of  all  but 
field  guns.  Now,  balls  will  take  effect  at  2,000 
yards,  and  the  result  is  seen  in  the  battle  of  Solfe- 
rino,  where  in  a  single  contest,  11,500  French, 
5,300  Sardinians,  and  21,000  Austrians  were 
wounded.  Another  noticeable  effect  of  improved 
firearms,  "  amies  de  precision,"  is  the  lodgment  of 
several  balls  in  a  single  person.  This  was  seen 
after  the  battle  of  Solferino,  where  soldiers  were 
found  to  have  several  wounds  of  different  origin 
in  the  same  person.  One  was  noticed  who  had 
received  four  balls  at  the  same  time.  The  late 
Col.  Baker,  who  fell  at  Leesburg,  Ya.,  is  said  to 
have  had  no  less  than  five  bullet  wounds.  It 
should  also  be  stated  that  the  additional  force 


MODERN  MILITARY  SCIENCE.  245 

given  to  projectiles  increases  largely  the  number 
of  wounds  from,  a  single  ball.  One  Enfield  rifle 
ball  lias  thus  been  known  to  wound  several  per- 
sons. The  improvements  in  the  destructive 
capacity  of  heavy  ordnance  are  in  kind  and  de- 
gree like  those  in  small-arms.  The  improvement 
in  projectiles  is  not  the  least  important  item  in 
the  comparison  of  the  present  and  the  past  state 
of  military  science.  The  round  musket-ball  was 
very  liable  to  be  diverted  in  its  course  by  bones, 
vessels,  tendons,  etc. ;  it  was  not  uncommon  to 
find  it  traversing  large  tracts  of  the  body  without 
seriously  wounding  important  organs,  or  parts. 
The  cylindro-conoidal  ball,  now  so  much  used,  is 
not  diverted  even  by  bone,  but  penetrates  di- 
rectly every  tissue  or  organ  in  its  track,  leaving 
the  most  dangerous  and  destructive  wounds. 
The  bearing  of  these  facts  upon  the  duties  of  the 
modern  military  surgeon  are  obvious.  Not  only 
are  his  duties  greatly  increased,  but  they  are  ren- 
dered far  more  difficult  than  formerly.  A  single 
battle  is  liable  to  overwhelm  the  surgical  staff 
with  labor,  to  the  great  distress  and  loss  of  the 
wounded.  Well  appointed  as  was  the  medical  staff 
of  the  French  army,  at  the  battle  of  Solferino 
hundreds  of  the  wounded  had  to  wait  for  days 
before  they  had  surgical  attendance.  At  Brescia, 
15,000  of  the  wounded  were  congregated  soon 
after  the  battle,  most  of  whom  were  in  urgent 
need  of  medical  and  surgical  aid.  In  our  san- 
guinary war,  we  witnessed  the  same  lamentable 


246  MODERN    MILITARY  SCIENCE. 

deficiency  in  the  medical  corps,  which  has  been 
more  and  more  apparent  in  recent  wars  ;  dwell- 
ings and  churches  were  often  crowded  with 
wounded  imploring  relief,  to  whom  no  other  re- 
lief came  than  death ;  hundreds  died  of  wounds 
which  admitted  of  prompt  succor.  We  hear  of 
surgeons,  who  frequently  stood  appalled  at  the 
magnitude  of  their  duties,  and  their  utter  inade- 
quacy to  the  task.  Foreign  States  have  in  some 
measure  supplied  these  deficiencies.  In  addition 
to  the  three  regimental  surgeons,  they  have 
organized  corps  of  ambulance  attendants,  train- 
ed to  the  proper  handling  of  the  wounded,  and 
who  are  made,  by  special  instruction,  sufficiently 
familiar  with  injuries  to  be  able  to  succor  the 
severely  wounded  on  the  field,  as  where  hemor- 
rhages are  imminent.  These  semi-medical  auxil- 
iaries to  the  staff  of  surgeons  are  of  great  service 
on  the  field.  They  follow  the  advancing  column 
closely  ;  examine  the  fallen  ;  if  their  wounds  are 
necessarily  immediately  fatal,  they  merely  place 
the  soldier  where  he  may  die  undisturbed  and 
uninjured.  If  the  wounds  do  not  demand  im- 
mediate surgical  attendance,  they  are  temporarily 
dressed  and  the  soldier  is  dispatched  to  the  per- 
manent hospital ;  but  if  they  require  immediate 
operation,  the  wounded  man  is  sent  to  the  field 
hospital,  where  the  surgeon  is  in  waiting  with 
assistance.  Thus  the  surgical  staff  is  prepared  to 
meet  every  emergency,  however  great  it  may  be. 


XLIX. 
HOSPITAL    APPOINTMENTS. 


THERE  can  be  no  doubt  that  a  new  era  in 
medical  education  has  begun  in  this  coun- 
try. The  marked  success  of  schools  connected  with 
hospitals  proves  too  unmistakably  that  theoreti- 
cal instruction  is  about  to  be  supplanted  by  the 
demonstrative.  It  is  vain  to  oppose  the  progress- 
ive change  in  the  public  mind.  It  is  based  on 
the  self-evident  truth  that  medicine,  a  science  of 
experiment  and  observation,  can  be  cultivated 
successfully  only  at  the  bed-side — a  truth  which 
all  the  logic  of  causistry  can  never  unsettle. 
That  truth  underlies  every  branch  of  scientific 
industry,  but  finds  in  practical  medicine  its 
highest  development  and  brightest  illustration. 
Science  and  art,  theory  and  practice,  are  one  and 
indivisible.  Science  teaches  the  mind,  and  art 
instructs  the  hand ;  the  former  gives  the  sound, 
discriminating  judgment,  and  the  latter  the  cun- 
ning skill  in  execution.  Both  are  alike  essential 
to  success,  both  are  to  be  acquired  together.  We 
advise  the  student  of  anatomy  to  dissect  with 
his  chart  before  him ;  and  why  should  we  not 
advise  the  student  of  practice  to  study  his  book 
at  the  bedside  ?     The  simple  truth  is,  we  have 


248  HOSPITAL  APPOINTMENTS. 

far   too   long   taught    medicine  by  an  artificial 
plan.     The  profession  has  not  been  governed  by 
the  same  good  sense  that  men  exercise  in  the 
ordinary  duties  of  life.     Let  us  now  call  atten- 
tion to  the  organization  of  hospitals,  when  re- 
garded as  the  great  centres  of  medical  education. 
They  have  hitherto  been  regarded  as  merely  the 
receptacles  of  the  sick.     In  their  organization  the 
comfort  of   the  inmates  has  been  the  especial 
care  of  their  guardians,  and  but  secondary  at- 
tention has  been  given  to  the  character  of  the 
medical  attendance.     They  have  been  rendered 
subservient  to  the  profession  as  practical  schools, 
where  the  physicians  and  surgeons  might  attain 
by  experience  and   observation  to  great  excel- 
lence.    The  large  majority  of  the  distinguished 
men  of  the  profession  have  held  positions  in  hos- 
pitals, and  in  these  large  fields  for  study  and 
accurate  investigation  have  acquired  that  skill 
which  has  given  them  success  in  practice.  Nearly 
all  of  the  familiar  names  which  adorn  the  pages 
of  medical  history  represent  so  many  different 
hospitals.     But  a  higher  and  nobler  service  is 
about  to  be  rendered  by  these  institutions,    They 
are  to  be  not  only  the  resort  of  the  sick,  and 
schools  for  the  training  of  a  few  physicians  and 
surgeons,  but  they  are  to  become  the  great  foun- 
tains of  medical  knowledge.     Within  the  hospi- 
tal ward  the  student  of  medicine  will  hereafter 
begin  and  complete  his  education.     The  school 
and  hospital  will  no  longer  be  separate  institu- 


HOSPITAL  APPOINTMENTS.  249 

tions,  but  tliey  must  be  the  same  in  location,  the 
same  in  name,  and  the  same  in  organization.    In 
this  view  it  becomes  a  matter  of  no  small  impor- 
tance, that  their  medical  and  surgical  staff  be 
selected  with  great  care.     Hitherto  the  govern- 
ing Boards  have  exercised  but  little  discretion  in 
the  choice  of  candidates  for  vacancies.     In  gen- 
eral,  that    person    has   been    chosen  who  has 
brought  the  largest  pressure  of  a  political,  social, 
or  pecuniary  kind  to  bear  upon  the  appointing 
power.     Merit  is  almost  universally  elbowed  out 
of  the  way  by  arrogant  conceit ;  and  places  of 
power  and  influence  are  filled  by  those  whom 
the  genius  of  medicine  would  discard.     For  this 
reason,  our  hospitals  have  been,  for  the  most 
part,  poorly  provided  with  medical  attendance. 
The  physicians  selected  are  rarely  the  growing 
and  advancing  members  of  the  profession.    They 
are  too  often  those  third-rate  mem  who,  in  prac- 
tical life,  necessarily  take  an  inferior  rank.    They 
are  not  familiar  with  the  late  discoveries  in  med- 
icine, nor  do  they  reflect  its  present  condition  ; 
errors  in  diagnosis  and  treatment  are  the  daily 
clinical  lessons  which  they  teach.     The  surgeons 
are   equally  unqualified    for    their    responsible 
positions.     Tbey  are  not  only  frequently  men  of 
no  science,  but  they  are  as  frequently  deficient 
in  ordinary  skill.     We  must  go  to  our  hospitals 
to  witness  poor  surgery.     Here  may  be  seen  the 
most  palpable  and  deplorable  errors,  openly  and 
shamelessly   committed.     We   shrink    from   the 
11* 


250  HOSPITAL  APPOINTMENTS. 

mention  of  the  terrible  lessons  which  incompe- 
tent surgeons  impress  upon  those  who  attend 
much  upon  public  practice.  If  the  study  of 
mal-practice  is  useful  to  the  student,  thon  do 
thoss  half-educated  physicians  and  surgeons, 
who  may  be  found  in  every  hospital,  serve  a  ben- 
eficial purpose  ;  their  lessons  are  certainly  most 
impressive.  The  medical  attendance  upon  these 
institutions  can  never  meet  the  present  and 
prospective  demands  of  the  profession  until  a 
new  system  of  appointment  is  adopted.  So  long 
as  Boards  of  laymen  may  choose  a  physician 
or  surgeon  from  among  candidates,  no  reliance 
can  be  placed  upon  their  choice.  They  may  by 
mistake  select  a  proper  person,  but  the  present 
staff  of  most  civil  hospitals  proves  that  the  con- 
trary must  be  the  result.  If  the  French  method 
of  deciding  by  concours  is  not  adapted  to  our 
social  peculiarities,  it  certainly  would  not  be 
difficult  to  devise  a  plan  by  which  the  unqualified 
could  be  distinguished  from  the  qualified  and 
the  former  be  prevented  from  securing  these  po- 
sitions. The  evil  is  one  which  will  not  correct 
itself,  but  like  many  others  must  be  fearlessly 
met  and  remedied.  And  the  remedy  must  be 
devised  and  applied  by  the  medical  profession. 
It  has  but  to  manifest  its  purpose,  and  assign 
the  reasons  therefor,  and  governing  boards  will 
yield  and  promptly  comply  with  its  demands. 


L. 
ASYLUMS    FOR    INEBRIATES. 


ri^HE  recognition  of  the  fact  that  those  inebri- 
ates who  have  been  considered  hopelessly 
devoted  to  their  cups,  are  laboring  under  a  spe- 
cies of  insanity  which  requires  their  restraint, 
will  form  the  brightest  feature  of  our  civilization. 
They  pervade   all  ranks  of   society,  and  have, 
hitherto,  like  lepers,  been  regarded  as  outcasts, 
for  whose  relief  the  grave  was  the  only  refuge. 
Whatever  may  be  the  social  position  of  the  dipso- 
maniac, a  more  pitiable  object  in  human  shape 
can  not  be  conceived.     Disease,  in  its  most  re- 
volting forms,  has  far  more  mitigating  conditions 
than  that  fatal  passion  which  clings  with  resist- 
less grasp  to  its  victim.     The  former  may  waste 
the  body,  and  render  life  intolerable  by  suffer- 
ing, but   leave   the    intellect    undisturbed,    and 
allow  the   affections   to   have   full   and   natural 
play.     But  the  latter  not  only  gradually  obliter- 
ates all  traces   of  original  manhood,  but  turns 
the  affections  into  fiendish  passions,   and  sub- 
merges  the   intellect   in   the    muddy  waters   of 
idiocy.     It  is  not  every  tippler,  or  even  drunk- 
ard, that  is  a  dipsomaniac,  but  it  is  the  man  over 
whom  appetite  has  so  far  triumphed  that  he  can 


252  ASYLUMS   FOR   INEBRIATES. 

no    longer    voluntarily    resist    the    temptation. 
Says  Dr.  Peddie : 

"  There  is,  especially  in  persons  of  a  nervous  or  sanguine 
temperament,  and  more  readily  in  women  than  in  men, 
a  condition  in  which  the  mere  vice  is  transformed  into  a 
disease,  and  the  mere  vicious  habit  into  an  insane  impul- 
sive propensity,  and  then  the  drunkard  becomes  a  dipso- 
maniac. *  *  *  He  becomes  destitute  of  any  command 
over  his  own  will,  of  all  ability  to  resist  the  craving,  and 
he  is  transformed  into  the  involuntary  slave  of  an  insane 
propensity.  Physically,  the  dipsomaniac  is  truly  lament- 
able to  behold,  with  his  general  broken-down  aspect, 
feeble,  tremulous  limbs,  pale  or  leaden-colored  visage,  and 
watery,  lustreless  eye.  But  in  the  manifestations  of  mind 
and  heart,  the  degradation  is  still  more  apparent  and 
mournful.  His  habits  of  drinking  are  not  now  social,  but 
solitary.  He  no  longer  drinks  from  mere  relish  for  the 
liquors  but  yields  to  a  desire  which  is  insatiable — giving 
himself  up  to  a  demon  which  has  taken  body  and  soul 
into  subjection.  Intelligence  is  extinguished ;  the  best 
affections  of  the  heart  are  deadened ;  the  moral  feelings 
are  perverted ;  the  dearest  social  ties  no  longer  restrain 
him;  truth  .is  no  longer  a  principle  of  action.  He  can 
not  now  control  his  conduct  or  manage  his  affairs ;  he  is 
useless  or  dangerous  to  himself  or  others ;  disqualified  for 
social  and  civil  duties,  a  wreck  of  humanity,  and  a  bur- 
den on  society." 

But  this  affection  may  be  hereditary,  and  thus 
resemble  a  constitutional  disease,  and  especially 
insanity.  It  is  no  uncommon  thing  to  find  in 
the  family  of  the  confirmed  drunkard,  children 
early  assuming  the  habits  of  the  parent,  and  ex- 
hibiting the  most  uncontrollable  passion  for  ar- 
dent spirits.     The  vice  of  the  parent  seems  also 


ASYLUMS  FOE  INEBRIATES.  253 

to  exist  in  a  two-fold  intensity  in  the  offspring. 
The  latter  is  early  lost  to  all  sense  of  shame,  and 
every  influence   is   powerless    towards    reform. 
But  whether    acquired   or  hereditary,   the   dis- 
ease   is    essentially    the     same,    and    requires 
the    same,  remedial   measures.     It   is   interest- 
ing to  notice  that    Dr.   Rush   entertained    the 
most  positive  views  in  regard  to  the  insanity 
of  inebriates.     He  considered  them  "  as  fit  sub- 
jects of  hospital  treatment  as  any  other  class  of 
madmen."     "  They  are  monomaniacs — the  sub- 
jects of  physical  disease  located  in  the  brain. 
At  first,  their  drinking  is  the  fruit  of  moral  de- 
pravity, but  when  long  indulgence  in  this  "vice 
has  produced  disease  of  the  brain,  then  is  their 
drinking  the  result  of  insanity."     The  remedy 
for  this  deplorable  malady  has  long  been  sought 
in  vain.     The  great  temperance  movement  in- 
augurated under  the  motto  "  Teetotalism,"  estab- 
lished one  important  conclusion,  viz.,  that  the 
most  inveterate  inebriate  may  be  rescued  if  the 
temptation  is  wholly  and  for  a  long  time   re- 
moved.    But  the  reformers  trusted  at   first  to 
the  resolution  of  the  reformed  solely,  and  the 
trial  necessarily  proved,  in  the  vast  majority  of 
cases,  a  failure.     Few   were    found   sufficiently 
strong  to  resist  the   temptation,  which  allured 
them  on  every  hand,  to  assuage  the  fever  which 
raged   consumingly   within.     The    advocates   of 
teetotalism  then  undertook  the  removal  of  the 
temptation  itself,  and  in  this  they  have  been  par- 


254:  ASYLUMS  FOE  INEBBIATES. 

tially  successful.  But  the  great  step  in  this  re- 
form was  the  recognition  of  the  true  physical, 
moral,  and  psychological  condition  of  the  inebri- 
ate. That  he  is  an  insane  person,  in  every  re- 
spect in  which  a  monomaniac  can  be  so  consid- 
ered, is  susceptible  of  demonstration.  The  logical 
conclusion  follows,  that  for  his  proper  treat- 
ment there  must  be  such  isolation  from  exciting 
causes,  and  such  moral  influences  as  will  best 
promote  recovery.  Of  the  value  of  Inebriate 
Asylums,  or  of  the  plan  of  isolation,  with  proper 
moral  and  hygienic  influences,  we  now  have  prac- 
tical as  well  as^  theoretical  testimony.  Many 
persons  have  been  secluded  at  their  own  request, 
and  have  thereby  been  saved  from  destruction. 
Many  illustrative  examples  might  be  given  of  the 
success  which  will  attend  seclusion,  but  we  will 
only  quote  from  the  report  made  by  Dr.  Christi- 
son,  of  a  visit  to  a  private  asylum  for  inebriates 
in  the  island  of  Skye,  Scotland.     He  says  : 

"  Here  we  found  ten  gentlemen — cases  originally  of  the 
worst  forms  of  ungovernable  drink-craving — who  lived  in 
a  state  of  sobriety,  happiness,  and  real  freedom.  One,  who 
is  now  well,  had  not  yet  recovered  from  a  prostrate  condi- 
tion of  both  mind  and  body.  The  others  wandered  over 
the  island,  scene-hunting,  angling,  fowling,  botanizing,  and 
geologizing ;  and  one  of  these  accompanied  my  compan- 
ion and  myself  on  a  long  day's  walk  to  Loch  Corruisk  and 
the  Cuchullin  mountains.  No  untoward  accident  had 
ever  happened  among  them.  I  may  add,  that  it  was  im- 
possible not  to  feel,  that — with  one  or  two  exceptions — 
we  were  among  a  set  of  men  of  originally  a  low  order  of 


^  ASYLUMS  FOR  INEBRIATES.  255 

intellect.  Radical  cures  are  rare  among  them ;  for  sucli 
men,  under  the  present  order  of  things,  are  generally  too 
far  gone  in  the  habit  of  intemperance  before  they  can  be 
persuaded  to  submit  to  treatment.  Nevertheless,  one  of 
those  I  met  there,  a  very  bad  case  indeed,  has  since  stood 
the  world's  temptations  bravely  for  twelve  months  subse- 
quently to  his  discharge." 

The  State  of  New  York  was,  we  believe,  the 
first  to  carry  out  practically  this  idea.  The  no- 
ble institution  at  Binghamton,  is  the  proudest 
monument  which  the  Empire  State  can  raise  to 
the  intelligence  and  humanity  of  its  people. 
Other  States  have  taken  up  the  subject,  and 
leading  men  are  earnestly  laboring  to  establish 
asylums  for  the  inebriate.  The  organization  of 
the  American  Association  for  the  cure  of  Inebri- 
ates is  an  important  movement,  designed  to  en- 
able the  friends  of  this  reform  to  cooperate 
throughout  all  the  States.  In  Great  Britain  the 
reform  has  taken  a  strong  hold  upon  the  medical 
profession  and  philanthropists,  and  great  exer- 
tions are  being  made  to  obtain  such  legislation 
as  will  enable  them  to  render  it  efficient  and  en- 
tirely practicable.  Dr.  Christison,  Dr.  Peddie, 
Dr.  Mackesey,  Dr.  Dalrymple,  and  others,  have 
brought  the  subject  prominently  forward,  and 
none  who  have  read  their  papers  fail  to  be  con- 
vinced of  the  vast  importance  of  the  reform.  In 
the  British  Social  Science  Association  the  sub- 
ject has  been  largely  examined,  and  we  may  soon 
expect  to  see  the  fruits  of  this  discussion  in  the 
adoption  of  such  legal  measures  as  are  required. 


LT. 
SUEGEON    AND    PATIENT. 


IT  is  not  generally  known  to  the  surgeon,  we 
believe,  that  he  gives  his  services  under  the 
form  of  a  contract.  This  agreement  may  be 
implied,  or  it  may  be  expressed  in  terms.  In 
either  case  he  is  responsible  for  the  fulfillment  of 
his  part  of  the  contract.  The  implied  contract 
grows  out  of  his  offering  his  services  to  the  pub- 
lic as  a  qualified  practitioner  of  his  art ;  and  in 
all  suits  for  alleged  medical  malpractice  under  it, 
the  courts  have  uniformly  held  that  the  practi- 
tioner is  bound  to  bring  to  his  case  the  ordinary 
degree  of  skill  in  his  profession.  In  the  legal 
phraseology  :  "  The  implied  contract  of  a  phy- 
sician or  surgeon  is  not  to  cure — to  restore  a 
limb  to  its  natural  perfectness — but  to  treat  his 
case  with  diligence  and  skill."  "His  contract, 
as  implied  in  law,  is  that — 1.  He  possesses  that 
reasonable  degree  of  learning,  skill,  and  experi- 
ence, which  is  ordinarily  possessed  by  others  of 
his  profession ;  2.  That  he  will  use  reasonable 
and  ordinary  care  and  diligence  in  the  treat- 
ment of  the  case  committed  to  him ;  3.  That  he 
will  use  his  best  judgment  in  all  cases  of  doubt 
as  to  the  best  course  of  treatment."     The  mean- 


^  SURGEON  AND  PATIENT.         257 

ing  of  the  term  "  ordinary  skill,"  has  given  rise 
to  much  discussion,  and  too  frequently  is  regard- 
ed by  lawyers  as  requiring  too  high  a  standard 
of  attainment.     An  eminent   English  jurist  de- 
clares that  all  surgeons  are  not  required  to  have 
the  skill  and  knowledge  of  Astley  Cooper,  but 
only   that    skill    which    gives    average    results. 
Judge  Story  says :   "  In  all  these  cases,  where 
skill  is  required,  it  is  to  be  understood  that  it 
means  ordinary  skill  in  the  business  or  employ- 
ment which  the  bailee  undertakes ;  for  he  is  not 
presumed    to    engage    for    extraordinary   skill, 
which  belongs  to  a  few  men  only  in  his  business 
or  employment,  or  for  extraordinary  endowments 
or  acquirements."     But  the  surgeon  may  make 
a  special  contract  with  his  patient,  and  then  he 
is  held  strictly  by  its  terms.     If  he  contract  to 
do  what  is  absolutely  impossible  at  the  time  the 
contract  was  made,  he  is  not  bound  thereby,  for 
a  man  cannot  be  compelled  to  perform  an  impos- 
sibility.    He  will  forfeit  all  compensation  for  his 
services.     If,  however,  he  contract  to  do  any- 
thing accidentally   impossible,    the    contract    is 
binding,  "  it  being  his  own  fault  and  folly  that 
he  did  not  expressly  provide  against  those  con- 
tingencies he  should  know  might  possibly  trans- 
pire, and  exempt  himself  from  responsibility  in 
certain  events."    The  surgeon  may  then  contract 
to  effect  an  absolute  cure ;  and  the  highest  de- 
gree of  skill,  combined  with  the  utmost  care  and 
diligence,  will  not  relieve  him  of  his  responsi- 


258  SURGEON  AND   PATIENT. 

bility,  "  because  it  was  his  own  fault,  or  inexcus- 
able ignorance,  that  so  uncertain  a  result  should 
have  been  guaranteed  successful.  The  extent  of 
the  physician's  or  surgeon's  liability,  under  an 
express  contract  to  cure,  will  depend  upon  the 
circumstances  of  the  case.  If  he  undertakes  an 
absolute  impossibility,  the  law  will  not  hold  him 
responsible  for  the  full  extent  of  the  damage  re- 
sulting to  the  patient  by  reason  of  the  failure  to 
cure.  His  responsibility  extends  to  a  forfeiture 
of  all  compensation  for  medicine  and  service  ; 
the  impossibility  of  the  undertaking  excuses  him 
in  part."  The  surgeon  who  makes  a  special  con- 
tract cannot  afterwards  plead  ignorance  or  want 
of  skill ;  he,  in  effect,  binds  himself  to  bring  to 
his  undertaking  a  degree  of  skill  and  knowledge 
equal  to  its  performance.  The  subject  of  spe- 
cial contracts  between  surgeon  and  patient  has 
been  reviewed  by  one  of  the  courts  of  the  State 
of  Ohio,  and  a  new  and  interesting  phase  has 
been  given  to  it.  A  suit  for  alleged  malpractice 
was  brought  in  due  form,  and  evidence  brought 
forward  to  prove  that  the  defendant  did  not  ex- 
ercise ordinary  care  and  skill.  The  defendant 
claimed  that  he  had  a  special  contract  with  the 
plaintiff  that  he  would  not  be  responsible  for  re- 
sults.    The  Court  charged  the  jury  as  follows  : 

"  A  physician  or  surgeon,  in  undertaking  the  treatment 
of  a  surgical  or  medical  case,  enters  into  a  contract  with 
the  patient.  In  the  absence  of  any  special  one,  the  gene- 
ral law  requires  that  the  physician  or  surgeon  shall  render 


SURGEON  AND  PATIENT.         259 

to  the  patient  the  ordinary  skill— not  the  highest  order  of 
skill,  nor  the  lowest,  but  something  like  the  average  skill 
of  the  profession.  The  general  law  also  requires  a  reason- 
able amount  of  care  on  the  part  of  the  physician  or  sur- 
geon. These  principles  are  applicable  to  persons  engaged 
in  other  pursuits.  A  mechanic  in  building  a  house,  or  a 
lawyer  in  the  management  of  a  case  at  the  bar,  is  respon- 
sible for  the  exercise  of  reasonable  skill  and  care.  The 
defendant,  Dr.  Butler,  however,  claims  that  he  had  a  spe- 
cial contract,  which  obligated  him  only  to  the  exercise  of 
the  skill  that  he  himself  possessed.  This  contract  the  de- 
fendant had  a  right  to  make ;  and  this  contract,  if  proven 
— a  matter  of  which  you  are  to  be  the  judges — is  the 
measure  of  his  responsibility,  in  the  case  at  issue,  for  sur- 
gical skill.'" 

Whereupon  the  jury  gave  a  verdict  for  the  de- 
fendant. If  this  decision  is  accepted  as  a  rule 
in  our  courts  in  suits  for  alleged  malpractice,  we 
see  no  reason  why  the  surgeon  may  not  always 
relieve  himself  from  all  liability  to  damages  in 
the  practice  of  his  profession.  He  has  only  to 
stipulate  that  he  will  use  all  the  skill  which  he 
himself  possesses,  a  fact  to  which  in  several 
States  he  may  be  a  witness,  and  a  nonsuit  would 
be  the  result.  The  necessity  of  protection  from 
the  prosecution  of  malicious  persons  has  been 
increasingly  felt  by  surgeons,  but  there  has  as 
yet  been  no  adequate  measures  of  relief  pro- 
posed. The  right  to  appear  in  one's  own  defence 
was  an  important  gain,  as  the  surgeon  can 
generally  so  explain  the  case  as  to  convince  the 
jury  of  the  propriety  of  his  practice.  But  a  con- 
tract properly  drawn  is  a  more  direct  and  avail- 
able safeguard. 


LII. 
WRITER'S    CRAMP. 


IT  occasionally  happens  that  a  person  long  ac- 
customed to  writing,  finds  at  length  that  his 
finger  or  fingers  execute  singular  and  unaccounta- 
ble movements ;  he  experiences  difficulty  in  re- 
taining his  pen  between  his  thumb  and  fingers, 
and  accordingly  he  grasps  it  more  tightly ;  it 
may  be  pushed  by  his  first  finger  over  the  nail  of 
his  thumb,  and  it  is  difficult  to  bring  the  pen 
back  to  its  place — a  finger  starts  suddenly,  and 
hence  his  writing  looks  unnatural.  The  same 
symptoms  are  sometimes  noticed  by  others,  as 
by  those  who  play  upon  instruments.  The  pi- 
anist may  have  such  spasmodic  action  of  a  finger 
as  to  touch  keys  which  he  intended  to  avoid. 
The  violinist  may  find  his  fingers  stiff  and  uncon- 
trollable. Laboring  people  may  suffer  in  a  simi- 
lar manner — as,  for  example,  the  seamstress 
pricks  her  fingers,  and  with  all  her  efforts  her 
stitching  is  irregular  ;  the  bricklayer  may  be  un- 
able to  use  the  trowel ;  the  milkmaid  may  be  un- 
able to  pursue  her  avocation;  the  tailor  and 
shoemaker  have  to  abandon  their  trades.  For  a 
long  period  these  symptoms  were  regarded  mere- 
ly as  peculiarities,  and  no  importance  was  at- 


WRITER  S   CRAMP. 


2G1 


tached  to  them.  It  did  not  occur  to  the  earlier 
observers  that  they  indicated  a  true  disease.  But 
such  proved  to  be  the  case,  and  the  affection  is 
now  known  as  "  Writers  Cramp,"  or  "  Scrivener's 
Palsy,"  because  it  is  more  often  met  with  in  this 
class  of  persons.  This  singular  disease  is  chronic 
in  its  form,  and  is  "  characterized  by  the  occur- 
rence of  a  spasm  when  the  attempt  is  made  to 
execute  a  special  and  complicated  movement  the 
result  of  previous  education."  At  first  the  spasm 
is  often  very  slight,  so  as  hardly  to  attract  atten- 
tion, and  when  the  effort  ceases  there  is  no  evi- 
dence that  there  is  any  special  affection.  But 
when  an  attempt  is  again  made,  the  spasm  re- 
turns. The  disease  is  liable  to  extend  and  in- 
volve other  fingers,  the  thumb,  and  even  more 
distant  muscles,  as  of  the  arm.  Persons  some- 
times endeavor  to  overcome  the  difficulty  by 
moving  the  entire  arm  in  the  act  of  writing,  and 
some  have  even  learned  to  write  with  the  other 
hand.  But  it  has  too  frequently  happened  that 
the  spasm  has  immediately  occurred  in  the  hand 
last  educated.  All  efforts  to  control  the  spasm 
and  force  the  affected  hand  into  action  has  re- 
sulted in  increasing  the  difficulty.  The  cause  of 
this  cramp  is  unknown.  It  has  been  supposed 
to  be  due  to  excessive  writing,  but  there  are  no 
facts  to  warrant  the  opinion.  Some  have  attrib- 
uted it  to  the  use  of  a  metallic  pen,  but  there  is  no 
proof  of  this  assertion.  The  truth  is  that  writing, 
like  playing  upon  a  piano,  is  a  very  complicated 


262 


WRITERS   CRAMP. 


act,  and  requires  great  coordinating  power.  It 
is  learned  with  difficulty,  as  many  muscles  have 
to  be  educated  to  act  in  harmony.  The  perform- 
ance of  the  function  of  every  muscle  depends 
upon  the  integrity  of  the  nerve  supplying  it,  and 
of  that  part  of  the  brain  from  which  the  nerve 
takes  its  origin.  A  slight  derangement,  there- 
fore, of  any  of  these  parts  interferes  or  destroys 
the  function  of  a  muscle  or  muscles,  and  the  re- 
sult is  interference  with  the  particular  act  previ- 
ously so  easily  and  rapidly  performed.  It  is  no 
uncommon  thing  to  find  a  loss  of  power  in  a  part 
which  destroys  some  most  important  function  of 
the  body.  In  writer's  cramp,  there  is,  from  some 
cause  unknown,  a  defect  in  the  power  of  coordi- 
nating movements  of  a  limited  kind,  but  yet  suffi- 
cient to  interrupt  a  series  of  movements  which 
we  have  been  educated  to  perform,  and  which 
have  through  long  practice  become  automatic. 
The  treatment  of  this  malady  is  simple,  and  con- 
sists in  rest.  When  the  patient  promptly  lays 
aside  the  particular  business  in  the  performance 
of  which  spasm  or  cramp  occurs,  recovery  is  al- 
most certain.  Every  effort  to  overcome  it  by 
persistent  use  of  the  part  only  increases  the  im- 
mediate spasm,  and  renders  it  more  liable  to  ex- 
tend and  involve  other  parts.  It  is  idle  to  attempt 
a  cure  by  any  known  medicinal  preparations. 
"When  recovery  is  complete,  the  patient  may  re- 
sume his  business,  but  he  must  not  overtax  the 
previously  affected  part.  Relapse  is  not  liable  to 
occur  unless  the  part  is  overworked. 


Lin. 

THE    GEEAT    DESTEOYEE. 


IT  may  safely  be  affirmed  that  there  is  no 
single  disease  in  the  long  catalogue  of  hu- 
man pestilences  that  has  created  greater  havoc 
and  been  more  justly  dreaded  than  small-pox — 
variola,  or  as  once  well  named,  the  Great  De- 
stroyer. Other  contagious  diseases  have  slain 
their  thousands,  but  small-pox  has  slain  its 
tens  of  millions.  It  has  destroyed  armies,  raised 
sieges,  and  scattered  whole  tribes  and  communi- 
ties of  people.  The  barbarian  devoutly  sacrifices 
to  its  deified  representation  when  it  appears,  and 
the  Christian  flees  as  from  the  presence  of  death. 
The  date  of  the  first  appearance  of  small-pox  is 
doubtful.  There  is  a  tradition  in  the  East  that 
it  was  first  derived  from  the  camel ;  but  there  is 
no  proof  of  the  truth  of  the  statement.  The 
"  sore  boils"  of  Job  have  been  attributed  to 
small-pox,  but  foolishly.  There  is  no  evidence 
even  that  the  Greek  and  Roman  physicians  knew 
of  this  disease.  Procopius,  who  lived  in  the 
middle  of  the  sixth  century,  gives  a  graphic  ac- 
count of  a  disease  closely  resembling  small-pox, 
which  began  A.  D.  544,  in  Egypt,  and  spread  to 
Constantinople.     In  A.  D.  569,  the  year  of  the 


264  THE   GREAT   DESTROYER. 

birth  of  Mohammed,  an  Abyssinian  army  was 
compelled  to  raise  the  siege  of  Mecca  by  a  pesti- 
lence very  like  small-pox,  which  created  a  terri- 
ble mortality.  The  first  medical  writer  who  gave 
an  authentic  description  of  the  disease  was 
Rhazes,  an  Arabian  physician,  who  wrote  about 
910.  From  that  period  the  pestilence  has  had 
many  historians,  and  we  have  no  difficulty  in 
tracing  its  progress  from  time  to  time,  and  esti- 
mating the  extent  of  its  ravages.  It  has  spread 
most  widely  where  there  have  been  the  largest 
movements  among  nations ;  as  in  the  conquests 
of  the  Arabs  and  Saracens,  during  the  crusades, 
in  the  emigration  of  the  Spaniards  to  America, 
etc.  Wherever  it  appeared  in  those  early  pe- 
riods, it  was  regarded  as  an  avenging  angel. 
Whole  continents  were  decimated,  and  some  na- 
tions were  almost  completely  annihilated.  It  is 
estimated  that  45,000,000  of  the  people  of  Eu- 
rope died  of  small-pox  in  the  one  hundred  years 
preceding  the  introduction  of  vaccination.  As 
late  as  1720,  20,000  persons  died  of  small-pox  in 
Paris.  It  did  not  respect  rank  or  condition. 
A  recent  writer  makes  the  following  statement  of 
its  ravages  in  the  royal  families  of  Europe : 
"  Among  the  family  of  Charles  I.  of  Great  Britain, 
of  his  forty-two  lineal  descendants  up  to  the  date 
of  1712,  five  were  killed  outright  by  small-pox  : 
viz.,  his  son  Henry,  Duke  of  Gloucester ;  and  his 
daughter  Mary,  wife  of  the  Prince  of  Orange,  and 
mother  of  William  III. ;  and  three  of  the  children 


THE   GREAT   DESTROYER.  265 

of  James  II. :  viz.,  Charles,  Duke  of  Cambridge, 
in  1677 ;  Mary,  Queen  of  England,  and  wife  of 
William  III.,  in  1694 ;  and  the  Princess  Maria 
Louisa,  in  April,  1712.  This  does  not  include,  of 
course,  severe  attacks,  not  fatal,  such  as  those 
from  which  Queen  Anne  and  William  III.  suffered. 
Of  the  immediate  descendants  of  his  contempo- 
rary, Louis  XIV.,  of  France  (who  himself  survived 
a  severe  attack  of  small-pox),  five  also  died  of  it 
in  the  interval  between  1711  and  1774 :  viz.,  his 
son  Louis,  the  Dauphin  of  France,  in  April,  of 
1711  ;  Louis,  Duke  of  Burgundy,  son  of  the  pre- 
ceding, and  also  Dauphin,  and  the  Dauphiness, 
his  wife,  in  1712  ;  their  son,  the  Due  de  Bretagne, 
and  Louis  XV.,  the  great-grandson  of  Louis  XIV. 
Among  other  royal  deaths  from  small-pox  in  the 
same  period  were  those  of  Joseph  I.,  Emperor  of 
Germany,  in  1711 ;  Peter  II.,  Emperor  of  Russia, 
in  1730 ;  Henry,  Prince  of  Prussia,  in  1767  ; 
Maximilian  Joseph,  Elector  of  Bavaria,  Decem- 
ber 30,  1777."  The  history  of  nearly  every  case 
shows  that  the  sick  were  abandoned  by  their 
most  devoted  friends,  and  left  to  die  or  recover 
alone.  The  mode  of  propagation  of  small-pox 
long  remained  doubtful.  That  it  could  be  com- 
municated by  actual  contact  (to  touch)  of  the 
sick  with  the  well,  or  by  contagion,  was  early  ap- 
parent, and  it  was  soon  demonstrated  that  the 
sick  infected  the  air  of  the  room  in  which  they 
lay.  It  became  in  time  well  established,  there- 
fore, that  the  disease  was  both  contagious  and 
12 


266  THE   GREAT  DESTROYER. 

infectious.  It  was  also  discovered  that  the  bed 
and  clothing  of  the  sick  absorbed  the  poison,  and 
afterward  gave  it  off  when  exposed  to  the  air, 
and  thus  communicated  the  disease.  These 
clothes  or  other  articles  were  called  fomites,  from 
their  power  of  retaining  the  poison.  The  porous 
walls  of  the  room  also  received  the  virus,  and 
would  give  it  to  the  next  occupant.  So  subtle, 
indeed,  did  the  poison  seem  to  be,  and  so  many 
sickened  without  known  contact  with  the  sick, 
that  it  came  to  be  believed  that  the  disease  was 
communicated  by  sight  and  by  hearing,  and  even 
by  the  imagination.  More  recent  investigations 
have  developed  the  theory  that  the  human  sub- 
ject is  born  with  certain  materials  in  his  blood  or 
tissues,  which  the  poisons  of  small-pox,  scarlet- 
fever,  or  measles  act  upon  as  yeast  acts  upon 
the  dough — namely,  as  a  ferment.  In  this  fer- 
mentation, the  peculiar  poison  multiplies  itself  in- 
finitely, and  shows  itself  in  the  efflorescence  or 
eruption.  But  it  destroys  wholly  or  in  part  the 
original  material  upon  which  it  acted  :  when  it 
entirely  destroys  this  material,  the  disease  can 
never  repeat  itself  in  the  same  person ;  when  the 
fermentation  is  partial,  the  disease  may  recur. 
This  theory  explains  also  the  nature  of  the  pro- 
cess of  inoculation  and  vaccination — the  two  great 
preventive  measures  of  small-pox  and  the  neces- 
sity of  revaccination  until  the  individual  has  no 
longer  any  susceptibility. 


LIV. 
STUDY  OF  MEDICAL  ETHICS. 


THE  Code  of  Ethics  of  the  American  Medical 
Association  has  now  been  the  recognized 
standard  of  medical  morals  in  this  country  for 
a  quarter  of  a  century.  It  was  prepared  by  the 
wisest  members  of  our  profession,  among  whom 
we  recognize  the  honored  and  trustworthy  names 
of  Drs.  Bell,  Hays,  and  Emerson,  of  Philadel- 
phia ;  Prof.  Clark,  of  New  York,  and  Prof.  Ar- 
nold, of  Georgia.  "When  submitted  to  the  Conven- 
tion of  1847,  the  Code  was  adopted  unanimously. 
Since  that  period  no  one  has  dissented  from  its 
provisions,  but  every  legitimate  medical  organiza- 
tion in  the  country  has  adopted  it ;  and  thus  it 
stands  as  our  organic  medical  law.  This  docu- 
ment defines  with  admirable  simplicity  and  pu- 
rity of  language,  and  with  the  nicest  appreciation 
of  the  exalted  spirit  of  scientific  medicine,  the 
duties  of  physicians  to  each  other  as  members  of 
a  liberal  profession,  and  the  reciprocal  obliga- 
tions which  exist  between  them  and  the  individual 
members  of  society.  It  is,  in  a  word,  the  guide 
to  the  formation  of  a  true  medical  character. 
And  yet  how  little  is  this  regarded  by  physicians, 
and  how  few  are  familiar  with  its  admirable  pro- 


268  STUDY   OF  MEDICAL  ETHICS. 

visions  ?  Of  the  hundreds  of  graduates  who  are 
annually  introduced  to  the  ranks  of  the  profes- 
sion, how  few  are  aware  of  even  the  existence  of 
such  a  chart  to  professional  excellence,  much  less 
imbued  with  its  spirit  ?  Annually,  on  the  com- 
mencement day,  some  venerable  physician  ad- 
dresses the  departing  graduates  ;  dwells  upon  the 
duties  and  responsibilities  awaiting  them  in  their 
new  relations  to  society;  encourages  them  by 
the  hope  of  success ;  stimulates  their  ambition 
by  the  example  of  great  lives  which  have  adorned 
the  profession  ;  then,  with  a  parting  blessing,  the 
young  Esculapians  are  dismissed  to  their  great 
encounter  with  the  realities  of  medical  practice. 
Such  advice  is  useful,  but  the  inquiry  naturally 
arises  whether  our  colleges  can  be  said  to  do  their 
whole  duty  toward  students  in  fitting  them  to 
practice  successfully,  when  they  fail  to  instruct 
them  in  those  rules  of  professional  intercourse 
whose  observance  brings  them,  antecedently  even 
to  intellectual  merits,  the  approbation  of  their 
fellow-practitioners,  and  on  the  contrary,  wrhose 
violation  insures  them  the  certain  and  immedi- 
ate reprobation  and  scorn  of  their  professional 
brethren.  If  an  individual  wishes  to  rise  to 
meritorious  eminence  in  any  profession  he  must, 
first  of  all  things,  secure  to  himself  the  sympathy 
and  the  respect  of  his  fellow-laborers.  "Without 
that  he  can  never  permanently  sustain  his  status 
among  gentlemen.  For,  although  he  may  rise 
spasmodically,  and  flutter  in  mid  air  awhile  upon 


STUDY  OP  MEDICAL  ETHICS.        2G9 

waxen  wings,  yet  the  inexorable  sunlight  of  Truth 
will  speedily  dissolve  these  frail  supports,  and 
leave  him  to  flounder  among  the  shoals  of  pre- 
tenders who  swarm  in  the  lower  depths  of  the 
profession.  It  does  not  follow  because  a  man 
has  acquired  large  stores  of  knowledge  that 
he  may  not  at  the  sanle  time  be  a  low  and  vul- 
gar boor,  whose  self-conceit  or  selfishness  leads 
him  to  trample  alike  upon  the  rights  and  the 
feelings  of  his  professional  brethren,  in  his  in- 
sensate haste  to  become  rich,  or  to  gain  the 
bubble  reputation.  These  things  are  of  too  fre- 
quent occurrence  not  to  have  been  noticed  by  all, 
and  it  is  not  difficult  in  any  community  to  point 
out  some  physicians  who,  great  enough  in  intel- 
lectuality, are  yet  moral  idiots  in  respect  to  the 
dignity  and  the  honor  of  the  profession  they  fol- 
low. Such  men,  whatever  their  talents,  their 
wealth,  or  their  factitious  distinctions,  are  still 
living  in  virtual  outlawry  to  the  canons  of  medi- 
cal ethics,  nor  can  the  ephemeral  praises  of  an 
indiscriminate  press  indemnify  them  for  the  lost 
sympathy  and  respect  of  their  fellows.  Pitiable 
indeed  is  the  condition  of  that  man  who  is  shun- 
ned by  his  peers,  whose  name  provokes  only  con- 
tempt, and  who  is  dismissed  from  the  thoughts 
as  one  fallen  from  the  high  estate  of  a  Christian 
gentleman  and  an  honorable  man.  Our  code 
of  ethics,  therefore,  in  all  its  length,  breadth, 
and  strength  of  application,  should  be  taught  to 
the  young  men  in  the  medical  colleges. 


LV. 

THE    GEAND    AKMY. 


FKOM  the  prostration  which  followed  the 
memorable  battle  of  Bull  Kim  the  country 
gradually  recovered,  new  armies  were  raised, 
equipped,  and  put  in  the  field,  surpassing  in 
numbers,  physical  perfection,  provisions,  and 
every  article  necessary  to  the  comfort  and  health 
of  the  individual  soldier,  any  army  of  modern 
times.  The  "  Grand  Army"  was  the  proud  title 
which  was  given  to  the  new  army  of  the  Potomac. 
The  nation  took  courage,  became  proud  of  its 
military  strength,  and  finally  stood  ready,  not 
only  to  crush  all  domestic  combinations  against 
its  authority,  but  to  arbitrate  diplomatic  ques- 
tions with  foreign  governments  on  the  field  of 
battle.  One  year  passed — a  year  of  battles,  of 
victories  and  defeats,  of  marchings  and  counter- 
marchings  innumerable.  The  country  rang  un- 
ceasingly with  the  clash  of  arms.  But  the  year 
closed,  as  it  commenced,  with  a  great  crisis. 
The  "  Grand  Army"  on  which  rested  the  hopes  of 
the  nation,  had  met  with  a  reverse  more  disheart- 
ening than  the  defeat  at  Bull  Run.  It  had  failed 
in  every  particular  to  accomplish  its  object,  and 
lay  on  the  inhospitable  banks  of  James  River, 


THE    GRAND   ARMY.  271 

weak,  worn,  and  wasted,  a  mere  remnant,  watch- 
ed over  and  protected  from  the  rapacious  enemy 
by  an  all-powerful  fleet.  That  year  was  replete 
with  valuable  but  dearly-bought  experiences  to 
us  an  unmilitary  people.  The  secret  of  most  of 
the  failures  of  this  army  was  comprised  in  a 
single  word — Sickness.  Study  the  campaigns  in 
whatever  light  we  may,  the  inevitable  conclusion 
is  that  its  defeats  were  almost  solely  due  to  sick- 
ness. At  the  close  of  that  year  one  hundred 
regiments  were  invalided,  and  this  represents  but 
a  fraction  of  the  actual  reduction  of  its  physical 
energy  and  strength.  The  campaign  on  the 
Peninsula  is  a  striking  example  of  the  utter  fail- 
ure of  a  large  and  well  appointed  army  to  accom- 
plish its  purpose,  when  little  or  no  regard  is  paid 
to  the  prevention  of  disease.  ^Within  the  short 
space  of  three  months  it  is  estimated  that  50,000 
men  were  sent  to  the  rear  of  the  "  Grand  Army 
of  the  Potomac."  During  that  time  it  was  within 
twelve  hours'  sail  of  the  Capitol,  and  Commissary 
stores  were  in  unlimited  quantities,  at  the  com- 
mand of  the  proper  officers.  The  army  marched 
less  than  a  hundred  miles  through  a  rich  farming 
country,  but  long  before  it  reached  the  point  for 
effective  operations  the  commanding  officer  was 
obliged  to  ask  to  have  his  army  renewed.  Du- 
ring this  time  there  was  no  prevailing  epidemic, 
nor  other  disease  which  a  careful  attention  to  the 
simplest  laws  of  hygiene  would  not  in  a  great  de- 
gree have  prevented.     The  first  cause  of  weak- 


272  THE   GRAND   ARMY. 

ness  was  due  to  mustering  into  service  unfit 
recruits.  This  had  been  done  to  a  most  danger- 
ous extent.  Boys  and  old  men,  men  suffering 
from  hernias,  varicose  veins,  chest  and  heart  dis- 
eases, etc.,  often  passed  muster  without  a  word 
of  objection.  There  are  many  instances  of  per- 
sons joining  the  army  because  their  diseases  in- 
capacitated them  for  active  business.  The  blame 
rested  with  the  medical  inspectors  appointed 
by  the  State  authorities.  These  inspectors  were 
in  some  instances  utterly  unfit  for  such  duty, 
being  unqualified  to  make  a  proper  medical  in- 
spection. At  one  of  the  most  important  recruit- 
ing stations  in  the  country  nearly  every  form  of 
disability  was  overlooked.  In  other  instances 
the  inspectors,  for  the  smallest  bribes,  passed 
men  whom  they  knew  to  be  unfit  for  the  service. 
An  army  made  up  of  such  material  has,  within  its 
very  earliest  organization,  the  seeds  of  disaster 
and  ultimate  failure.  The  army  of  the  Potomac 
was  composed  of  much  of  this  material,  which 
was  not  very  apparent  while  in  camp,  and  sub- 
jected to  no  other  fatigue  than  the  daily  drill. 
But  the  first  decided  movement  diminished  the 
number  of  soldiers,  but  not  the  strength  of  the 
army,  by  thousands.  This  class  of  persons  also 
filled  the  hospitals  throughout  the  entire  season. 
The  first  exposure  to  the  inclemencies  of  the 
weather  and  .to  fatigue,  invalided  them  for  the 
period  of  their  enlistment.  A  second  palpable 
cause  of  disease  was  the  unhealthy  location  and 


THE   GRAND   ARMY.  273 

inadequate  provision  of  camps.     There  is  doubt- 
less   an    occasional    military   necessity  for   the 
location  of  a  camp  on  grounds  unfit  for  the  resi- 
dence of  man,  but  this  is  seldom,   and  almost 
never  of  long  duration.     And  yet  the  army  of  the 
Potomac  was  scarcely  ever  on  healthy  grounds, 
though  often  in  the  immediate  vicinity  of  healthy 
localities.     "When  it  broke  camp  in  March,  the 
troops  were  marched  rapidly  to  Manasses,  thence 
back  to  the  Potomac,  upon  the  banks  of  which 
they  lay  for  three  weeks  waiting  for  preparations 
for  the  expedition  to  be  completed.     During  that 
time  they  were  almost  within  sight  of  their  com- 
fortable  but  deserted   tents,   with   no   covering 
other  than   meagre  shelter  tents.     As  a  conse- 
quence the  hospitals  of  Alexandria  and  every 
available  building  were  filled  with  soldiers  suffer- 
ing from  rheumatism,  pneumonia,  pleurisy,  etc. 
When  at  length  the  army  moved  to  the  Penin- 
sula, the  most  unhealthy  localities  were  selected. 
The  extensive  low  grounds  at  the  mouth  of  James 
river,  which  during  the  spring  season  are  covered 
with  pools  of  stagnant  water,  were  occupied  by 
the  army.     Here  they  remained  for  weeks  with 
the  same  meagre  tents,  and  the  same  result  fol- 
lowed as  at  Alexandria.     The  hospitals  were  soon 
crowded  with   every  form  of  disease  dependent 
upon  exposure ;    so  excessive  was  the  sickness 
that  hospital  tents  in  large  numbers  were  erected 
in  the  vicinity,  and  all  were  crowded.     Here  the 
Grand  Army   had   its   strength   sadly  reduced. 
12* 


27-4  THE  GRAND  ARMY. 

Moving  forward  to  the  scene  of  its  first  opera- 
tions the  army  sat  down  before  Yorktown.  Again 
the  camping  grounds  were  selected  with  no  better 
care,  and  combined  with  this  fertile  source  of  dis- 
ease was  hard  labor  in  the  mud  and  cold.  From 
this  point  the  transports  were  busily  engaged  for 
weeks  in  conveying  the  sick  away  to  distant  hos- 
pitals. The  depletion  of  the  force  here  was  so 
great  as  to  excite  apprehension  that  this  army 
might  not  be  able  to  cope  with  its  adversary.  After 
the  evacuation  of  Yorktown,  the  army  pressed  on 
by  hurried  marches  to  the  Chickahominy,  where 
it  again  sat  down  in  the  very  stench  of  malaria. 
The  reduction  of  its  numerical  and  physical 
strength  now  became  frightful  and  alarming.  It 
was  rapidly  melting  away  in  the  very  face  of  the 
enemy  beyond  all  power  of  recuperation.  In  the 
final  struggle  its  commanding  general  required 
50,000  more  men  than  he  had,  but  that  precise 
number  had  been  invalided  from  its  ranks  through 
gross  neglect  of  their  health  and  comfort.  A 
third  cause  of  disease  was  a  disregard  of  camp 
police.  Cleanliness  of  the  grounds,  and  cleanli- 
ness of  the  person,  were  in  general  most  shame- 
fully neglected,  and  the  result  has  been  diseases 
of  the  severest  type.  In  vast  numbers  of  regi- 
ments of  the  Grand  Army,  every  form  of  nuisance 
had  been  allowed  to  accumulate  on  the  ground 
and  in  and  around  the  tents.  In  these  regiments 
personal  neatness  was  not  even  thought  of.  No 
trite  apology  of  "  military  necessity"  can  excuse 


THE    GRAND   ARMY.  275 

a  neglect  of  cleanliness — the  first  element  of 
health.  A  fourth  cause  of  disease  was  improper 
and  badly  cooked  food.  The  supply  of  food  in 
the  gross  to  the  army  was  not  deficient,  except 
in  extraordinary  cases.  Government  was  lavish 
in  this  respect,  and  no  pains  were  spared  to  give 
a  good  supply  of  food.  But  the  most  consum- 
mate knaves  were  allowed  to  make  the  purchases, 
and  so  fearfully  did  they  impose  upon  her  confi- 
dence that  the  term  Commissary  was  a  by-word 
and  a  hissing  in  the  army.  Every  article  that 
could  be  adulterated,  was,  so  thoroughly,  that  of 
many  articles  the  original  could  not  be  detected  by 
the  senses.  And  yet  for  all  these  stores  the  Gov- 
ernment had  originally  paid  the  highest  market 
price.  In  regard  to  the  cooking  it  is  safe  to  say 
that  the  food  could  not  be  well  made  more  un- 
palatable and  indigestible.  An  hour  spent  at 
surgeon's  call  convinced  any  one  of  the  truth  of 
this  statement ;  the  greater  number  of  those  suf- 
fering slight  indisposition  complained  that  they 
"could  not  keep  the  food  on  their  stomachs." 
The  history  of  the  disastrous  peninsular  cam- 
paign of  the  Grand  Army  in  1862,  reveals  the 
sources  of  weakness  in  modern  armies.  All  de- 
tails are  carefully  attended  to,  except  those  on 
which  the  strength  and  effectiveness  of  the  forces 
depends.  It  will  be  seen  that  the  chief  causes  of 
failure  were  easily  preventable  ;  they  grew  out 
of  the  violation  of  some  of  the  simplest  laws  of 
hygiene.     Good  camping  ground  can,  with  but 


276  THE   GRAND   ARMY. 

an  occasional  exception,  be  selected  without  in 
the  slightest  degree  interfering  with  the  military 
plans  of  a  commandant ;  tents  and  their  neces- 
sary furniture  may  be  preserved,  as  a  general 
thing,  if  proper  care  is  exercised.  A  disregard 
of  camp  police  and  personal  cleanliness  is  an  un- 
justifiable neglect  of  the  plainest  laws  of  health. 
In  the  matter  of  the  supply  of  food,  a  system 
could  be  adopted  which  would  bring  to  the 
camp  the  best  article  in  market.  Cooks  should 
be  sent  with  the  army,  whose  whole  duty  is  to 
attend  to  the  care  and  preparation  of  the  food. 
Finally,  the  advice  of  the  medical  officers  should 
not  only  be  sought  on  all  questions  relating  to 
the  camp,  the  food,  the  clothing,  etc.,  but 
equally  in  all  movements  of  the  army.  If  a 
campaign  is  to  be  undertaken  the  most  perfectly 
projected  plans  must  have  the  sanction  of  the 
chief  of  the  medical  staff  to  insure  success.  In 
the  late  war  this  fact  was  repeatedly  demon- 
strated. Important  campaigns  were  elaborately 
arranged  by  commanding  officers,  but  the  medi- 
cal staff  was  only  consulted  as  to  supplies ;  the 
result  was  failure  owing  to  excessive  sickness. 
To  the  General  medical  counsels  are  as  essen- 
tial to  success  in  planning  and  executing  cam- 
paigns as  are  the  maps  of  the  coast  survey  to  the 
Admiral  who  is  about  to  attack  a  hostile  seaport 
town.  The  former,  like  the  latter,  deliberately 
invites  disaster  and  defeat,  when  he  ignores  the 
guide  to  success. 


LVL 
RESPONSIBILITY  OF  PHYSICIANS. 


11HE  question  of  the  responsibility  of  the 
physician  in  the  administration  of  chloro- 
form, or  for  alleged  injuries  resulting  there- 
from, has  at  length  been  decided  in  a  Court  of 
Law.  The  case  was  tried  at  Philadelphia  before 
Judge  Hare,  and  a  jury,  and  among  the  wit- 
nesses we  notice  the  names  of  Professors  Gross 
and  Goddard.  The  evidence  in  this  case  and 
the  charge  of  the  Judge  have  an  important  bear- 
ing upon  practice.  The  plaintiff,  Mr.  Bogle,  was 
a  driver  on  the  horse-cars,  and  was  thrown  from 
his  car,  striking  his  head  against  a  tree-box.  He 
was  taken  up  insensible,  but  so  far  recovered  as 
to  resume  his  work  on  the  following  day.  Some 
three  months  after  the  accident,  Mr.  B.  called  on 
Dr.  Winslow,  a  dentist,  to  have  several  teeth  ex- 
tracted. Chloroform  was  administered,  and  it 
was  found  necessary  to  give  it  in  large  quanti- 
ties, and  for  three-quarters  of  an  hour,  and  in 
the  intervals  between  the  drawing  of  the  differ- 
ent teeth,  as  signs  of  returning  consciousness 
appeared.  The  operation  completed,  Mr.  B.  left 
in  company  with  a  lady  friend,  but  he  staggered 
like  a  drunken  man,  and  was  obliged  to  lean  on 


278  RESPONSIBILITY   OF   PHYSICIANS. 

his  companion  for  assistance.  He  grew  worse 
after  that ;  his  tongue  thickened  so  that  his 
articulation  became  indistinct,  and  finally,  on 
the  fourth  day,  he  had  paralysis  of  the  left  side. 
Dr.  Winslow  was  called,  and  treated  him  for  this 
sickness  for  four  weeks,  at  the  end  of  which 
time  no  perceptible  relief  having  been  afforded, 
another  physician,  Dr.  Longshore  was  employed, 
under  whose  treatment  he  remained  until  he  was 
able  partially  to  resume  his  employment.  For 
the  loss  sustained  by  him  by  reason  of  his  sick- 
ness and  continued  inability  to  attend  to  his  du- 
ties the  suit  was  instituted.  Dr.  Longshore,  the 
principal  witness  on  the  part  of  the  prosecution, 
testified  that,  after  hearing  the  evidence  in  the 
case,  he  inferred  that  the  chloroform  was  the 
cause  of  the  paralysis  ;  never  knew  chloroform  to 
be  given  without  producing  paralysis  ;  that  is  its 
purpose  ;  it  is  not  permanent,  however ;  there  are 
cases  reported  in  the  books  of  paralysis  of  the 
tongue  resulting  from  the  use  of  chloroform ; 
never  heard  of  a  case  of  paralysis  of  the  side ; 
chloroform  might  produce  paralysis  of  the  side 
by  reason  of  its  effect  upon  the  brain  ;  cerebral 
haemorrhage  produces  paralysis  ;  never  heard  of 
a  case  of  cerebral  haemorrhage  produced  by 
chloroform  ;  the  kick  of  a  horse  will  produce  it ; 
does  not  think  it  resulted  from  such  a  cause  in 
this  case ;  there  is  no  standard  for  a  dose  of 
chloroform ;  the  operator  must  be  governed  by 
the  action  of   the  patient ;  if  the  effect  was  not 


RESPONSIBILITY   OF  PHYSICIANS.  279 

produced  in  three-quarters  of  an  hour  I  would 
stop  the  use  of  the  chloroform,  as  I  would  be 
afraid  of  the  consequence  ;  there  might  have 
been  an  injury  to  the  brain,  brought  into  action 
by  the  use  of  chloroform,  but  if  it  resulted  from 
injuries  received  two  months  before,  there  would 
be  complaints  on  the  part  of  the  patient.  Dr. 
Harbeson  testified  that  he  knew  of  a  case  where 
paralysis  was  caused  by  the  use  of  chloroform  ; 
a  tumor  had  been  removed  from  the  left  breast 
of  a  patient  while  under  the  influence  of  chloro- 
form, and  paralysis  ensued  ;  it  was  considered  a 
dangerous  agent,  and  was,  for  that  reason,  not 
used  at  the  Pennsylvania  Hospital ;  he  had 
known  of  death  resulting  from  its  use.  The  de- 
fence set  up  was,  that  Dr.  "Winslow  was  a  gradu- 
ate of  twenty  years'  practice,  eminently  skilled 
in  the  use  of  chloroform,  and  that  no  matter 
how  large  the  quantity  used,  or  its  length  of  ap- 
plication, no  such  effect  as  paralysis  could  result. 
Besides,  it  was  on  evidence  that  in  the  preceding 
January,  the  plaintiff  had  been  kicked  in  the 
breast  by  one  of  his  horses,  hurled  over  the 
dasher  into  the  street,  and  against  the  curb,  his 
head  violently  striking  a  lamp-post,  and  it  was 
contended  that  this  was  more  likely  to  have  been 
the  cause  of  the  paralysis.  The  character  of 
the  evidence  on  the  part  of  the  defence  may  be 
gathered  from  the  testimony  of  Professor  Gross. 
He  testified  that  chloroform  is  regarded  by  the 
profession  in  general  as  a  proper  agent  to  relieve 


280  RESPONSIBILITY   OF   PHYSICIANS. 

pain  ;  it  is  one  of  the  approved  remedies  of  the 
profession  ;  in  the  present  case  he  considered  the 
length  of  time  resulted  from  the  want  of  the 
proper  number  of  assistants  by  Dr.  Winslow ; 
don't  think  there  is  any  case  on  record,  except 
two  referred  to  by  Dr.  Longshore,  that  chloro- 
form caused  paralysis ;  these  two  are  cases  re- 
ported by  Dr.  Haphold,  of  South  Carolina,  and 
these  cases  are  not  authentic  ;  he  has  given  chlo- 
roform since  1842,  and  under  almost  all  circuni- 
tances ;  to  a  child  of  six  weeks  of  age,  and 
to  a  person  of  seventy-five  years  of  age ;  he  had 
given  it  to  all  classes,  and  never  witnessed  any 
ill  effects  from  it ;  he  did  not  think  that  the  par- 
alysis in  this  case  was  the  result  of  the  chloro- 
form ;  in  his  judgment  it  had  nothing  to  do  with 
it.  Professor  Gross  explained  the  effects  of  a 
concussion  of  the  brain  in  producing  paralysis ; 
several  months  might  elapse  between  the  injury 
and  the  paralysis;  he  thought  it  not  unlikely 
that  the  patient  would  complain  of  headache,  etc. ; 
though  it  did  not  follow  that  he  would  actually 
complain ;  if  the  man  had  not  been  kicked  by  a 
horse,  he  would  not  attribute  the  paralysis  to 
chloroform  from  what  he  knew  of  its  effects  ;  he 
had  given  several  ounces  to  patients ;  in  Louis- 
ville he  gave  a  man  eight  ounces,  and  kept  him 
under  its  influence  for  three  hours  ;  chloroform, 
like  many  other  agents  which  a  physician  is  ob- 
liged to  use,  is  dangerous  ;  so  is  laudanum,  etc. ; 
if  improperly  used  it  would  not  produce  paraly- 


RESPONSIBILITY   OF   PHYSICIANS.  281 

sis  ;  he  would  not  consider  it  improper  to  con- 
tinue the  use  of  chloroform  after  a  patient  has 
resisted  its  influence  three-quarters  of  an  hour  ; 
he  should  continue  for  five  hours,  until  he  had 
accomplished  his  object ;  a  patient  who  resists 
only  proves  that  he  has  not  taken  enough.  The 
charge  of  Judge  Hare  is  remarkable  for  its  clear 
enunciation  of  the  principles  which  should  guide 
the  jury  in  arriving  at  conclusions  as  to  the  exist- 
ence of  malpractice  in  this  or  any  other  case. 
He  said  : 

"  We  know  nothing  of  the  effects  of  the  agents  of  this 
description,  except  from  experience,  and  the  records  of 
that  experience  are  to  be  found  in  scientific  works,  and  the 
evidence  of  men  who  have  made  it  the  subject  of  their  study. 
The  jury  are,  however,  to  decide  in  the  last  resort ;  but 
even  if  they  doubt  the  safety  of  the  agent  employed,  there 
is  still  a  consideration  of  the  highest  reason  which  they 
ought  not  to  disregard.  All  science  is  the  result  of  a 
voyage  of  exploration,  and  the  science  of  medicine  can 
hardly  be  said  to  have  yet  reached  the  shore.  Men  must 
be  guided,  therefore,  by  what  is  probably  true,  and  are  not 
responsible  for  their  ignorance  of  the  absolute  truth  which 
is  not  known.  If  a  medical  practitioner  resorts  to  the 
acknowledged  proper  sources  of  information,  if  he  sits  at 
the  feet  of  masters  of  high  reputation,  and  does  as  they 
have  taught  him,  he  has  done  his  duty,  and  should  not  be 
answerable  for  the  evils  which  may  result  from  errors  in 
the  instruction  which  he  has  received.  Medical  opinion 
varies  from  time  to  time.  What  is  taught  at  one  period 
may  be  discovered  to  be  erroneous  at  another ;  but  he 
who  acts  according  to  the  best  known  authority,  is  a  skil- 
ful practitioner,  although  that  authority  should  lead  him, 
in  some  respects,  wrong.    He  will  then  have  done  all  that  he 


282  RESPONSIBILITY  OP  PHYSICIANS. 

can,  all  that  is  given  to  man  to  do,  and  may  leave  the  re- 
sult, without  self-reproach,  in  the  hands  of  a  higher  power. 
If,  however,  you  should  decide  that  chloroform  was  an  im- 
proper agent,  or  that  it  was  erroneously  administered  in 
this  instance,  you  will  then  have  to  consider  whether  the 
paralysis  was  the  result  of  its  administration.  *  *  *  * 
If  we  were  to  traverse  the  whole  circle  of  mankind,  we 
might  possibly  find,  even  among  healthy  men,  some  one 
who  could  be  paralyzed  by  its  influence,  or  if  not,  still 
among  the  numerous  diseases  with  which  man  is  afflicted, 
there  may  occur  peculiar  conditions  of  the  system  in  which 
chloroform  may  tend  to  paralysis.  This  topic  is  not  irrel- 
evant, because  the  medical  testimony  here  is,  that  the 
severe  blow  on  the  head  received  by  the  plaintiff  might 
have  produced  a  latent  disease  only  requiring  some  excit- 
ing cause  to  rouse  it  to  activity.  If  the  plaintiff  was  from 
previous  circumstances,  predisposed  to  paralysis,  it  might 
well  happen  that  the  extraction  of  his  teeth  without  the 
chloroform,  or  the  use  of  chloroform  without  the  extrac- 
tion, would  bring  on  a  paralytic  attack.  Even  if  this  was 
the  case,  still  it  would  not  be  just  to  make  the  defendant 
answerable  for  consequences  which  he  could  not  fore- 
see, which  were  not  the  ordinary  or  probable  results 
of  what  he  did.  He  was  only  bound  to  look  to  what  was 
natural  and  probable,  to  what  might  reasonably  be  antici- 
pated. There  is  nothing  to  show  that  he  was  made 
acquainted  with  the  accident  that  had  befallen  the  plain- 
tiff, or  had  any  reason  to  suppose  that  there  was  greater 
danger  in  his  case  than  that  of  other  men  Unless  some 
such  guard  is  thrown  around  the  physician,  his  judg- 
ment may  be  clouded  or  his  confidence  shaken  by  the 
dread  of  responsibility  at  the  critical  moment,  when  it  is 
all-important  that  he  should  retain  the  free  and  undis- 
turbed enjoyment  of  his  faculties,  in  order  to  use  them  for 
the  benefit  of  the  patient." 


LVII. 
MEDICAL  MEN  vs.  MEDICAL  MEN. 


A  CASE  has  recently  been  tried  in  an  Eng- 
lish court,  which  strikingly  illustrates  the 
moral  obliquity  of  some  members  of  our  profes- 
sion, when  called  to  the  witness  stand  during 
the  trial  of  a  medical  brother.  Instead  of 
appearing  and  testifying  as  members  of  a  com- 
mon brotherhood,  the  honor  and  dignity  of  which 
they  are  bound  to  protect,  they  improve  the 
occasion  to  show  to  the  world  how  futile  are 
medical  facts  and  observations ;  and  instead  of 
defending  a  professional  brother  from  the  malici- 
ous aspersions  of  character  to  which  he  is  sub- 
jected in  the  performance  of  his  duties,  they  join 
in  the  prosecution,  and  state  their  opinions  in 
such  manner  as  to  prejudice  a  jury  against  the 
unfortunate  defendant.  The  case  alluded  to  is 
especially  aggravating  from  the  nature  of  the 
prosecution  and  the  character  of  the  medical 
evidence  adduced.  The  following  are  the  facts 
as  given  by  a  London  contemporary  : 

"  Dr.  W gives,  kindly  and  unfortunately,  his  gra- 
tuitous services,  at  his  own  house,  to  a  hysterical  female, 
the  servant  of  one  of  his  patients.  He  examines  her  with 
the  speculum,  finds  superficial  ulceration  of  the  os  uteri, 


284  MEDICAL   MEN   VS.    MEDICAL   MEN. 

and  applies  lunar  caustic  six  or  eight  times.  The  woman 
is  long  under  his  observation.     She  at  last  goes  to  Malvern, 

where  she  comes  under  Dr.  G 's  care,  and  complains  of 

a  swelling  in  her  stomach,  the  nature  of  which  was  not 
appreciated  by  the  extensive  experience  in  hydropathy  and 
homcepathy  of  the  presiding  doctor.  Eventually,  and  to 
her  great  astonishment  (?),  the  female  is  delivered  of  the 
tumor  in  the  shape  of  a  child.  She  was,  as  her  tale  runs, 
made  insensible  during  two  hours  by  a  potion  adminis- 
tered to  her  by  Dr.  W ,  and  in  that  condition  the  deed 

was  effected.  She  named  the  time  and  day  on  which  the 
thing  was  done.  This  was  her  statement,  which  the  jury 
by  their  verdict,  and  the  judge  in  his  charge,  pronounced 
to  be  an  infamous  lie.  The  woman  was  of  the  class  of 
clever,  cunning,  hysterical  impostors;  and  by  her  plausi- 
bility had  won  the  complete  confidence  of  her  mistress* 
who,  out  of  kindness  to  her  servant,  was  determined  to 

have  justice  done  upon  Dr.  W' .     We  need  hardly  add 

that  there  was  not  a  shadow  of  suspicion  attaching  to  Dr. 

W in  the  matter.     He  has  been  most  cruelly  subjected 

to  an  accusation  to  which  every  member  of  the  profession 
is  every  hour  liable.  And  therefore  it  is  that  he  has  espe- 
cially the  right  to  ask  at  the  hands  of  his  medical  brethren 
their  warmest  sympathy  and,  if  need  be,  pecuniary  sup- 
port." 

The  charge  here  made  was  of  the  gravest 
nature,  affecting  at  once  the  honor  of  the  pro- 
fession and  the  moral  character  of  a  physician 
of  hitherto  good  reputation.  It  would  not  seem 
possible  that  a  medical  man,  having  any  re- 
gard for  justice  or  for  his  profession,  could  be 
found  who  would  consent  to  support  such  a 
prosecution  by  his  testimony  as  a  scientific 
expert.     And  yet  three  medical  men  were  pro- 


MEDICAL  MEN   VS.   MEDICAL  MEN.  285 

duced  on  the  part  of  the  prosecution,  and  all  well 
known  in  this  country  as  high  authorities.  They 
were  Dr.  Koberfc  Lee,  Dr.  Eamsbotham,  and  Dr. 
Taylor.  It  is  impossible  to  read  the  evidence 
of  these  witnesses  without  a  feeling  of  deep 
mortification.  We  can  not  divest  ourselves  of 
the  impression  that  there  is  exhibited  a  singular 
want  of  candor  and  honesty,  and  a  disposition  to 
view  the  subject  in  a  light  unfavorable  to  the 
defendant.  Dr.  Lee  seems,  indeed,  to  have  taken 
the  position  of  a  public  prosecutor.  He  declared 
that  no  ulceration  of  the  os  uteri  had  ever  existed, 
and  that  the  speculum  had  been  employed  for 
the  purpose  of  seduction.  He  took  occasion  to 
denounce  the  use  of  the  speculum,  and  it  is 
stated,  "  after  leaving  the  witness-box  he  con- 
spicuously continued  to  display  his  disapproba- 
tion of  the  instrument  by  publicly  exhibiting 
specula  of  various  shapes  and  sizes  in  the  body 
of  the  Court,  before  the  judge  and  jury,  and 
passing  them  round  for  the  special  inspection  of 
the  apparently  much  amused  rows  of  barristers." 
A  London  journal  thus  justly  comments  on  his 
testimony  : 

"There  is  not  an  honorable  mind  in  the  entire  kingdom 
that  did  not  experience  a  sense  of  shame  when  reading  the 
examination  of  Dr.  Robert  Lee.  Gross  in  its  levity  and 
reckless  in  its  assertion,  as  devoid  of  good  feeling  as  it  was 
deficient  in  scientific  truth,  it  formed  an  exhibition  than 
which  anything  more  degrading  to  science  and  disgraceful 
to  his  profession  can  not  be  imagined.  It  was  gross  in  its 
levity,  for  Dr.  Robert  Lee  forgot  that  the  fame,  fortune, 


286  MEDICAL   MEN  VS.   MEDICAL  MEN. 

and  future  of  a  man  of  equal  reputation  with  himself  were 
involved  in  his  testimony,  and  selected  such  an  opportunity 
for  idle  badinage  and  personal  puff;  reckless  in  its  asser- 
tion, because  at  variance  with  the  experience  and  writings 
of  men  of  the  highest  reputation.  It  was  devoid  of  good 
feeling,  inasmuch  as  the  accusation  was  one  that  every  right- 
minded  man  must  have  supported  with  pain  rather  than 
battled  for  with  zeal ;  deficient  in  scientific  truth,  if  Dr. 
Robert  Lee's  own  publications  ten  years  ago  are  to  be 
trusted,  which  he  however  declares  (and  in  this  we  agree) 
are  as  destitute  of  authority  as  others  now  consider  his 
present  testimony  to  be.  It  was  degrading  to  science  and 
disgraceful  to  his  profession,  as  involving  the  declaration 
that  those  who  have  spent  their  lives  in  medical  practice 
and  study,  profit  so  little  by  their  labors  that  they  need 
lessly  violate  the  sanctity  of  the  female  person  in  the  gross 
abuse  of  an  instrument  admittedly  necessary  for  the  treat- 
ment of  disease." 

Dr.  Eamsbotham  supported  Dr.  Lee's  theory, 
but  in  a  much  more  subdued  strain.  Still,  he 
spoke  like  one  committed  to  a  cause  which  he 
felt  bound  to  sustain.  The  same  is  true  of  the 
testimony  of  Dr.  Taylor.  In  spite  of  these  emi- 
nent men  on  the  part  of  the  prosecution,  the 
verdict  of  the  jury  acquitted  the  defendant. 
Thus  ended  a  most  malicious  attempt  to  destroy 
the  reputation  of  a  medical  man  by  means  of 
scientific  experts,  who  readily,  we  fear  volun- 
tarily, allowed  themselves  to  become  participes 
criminis.  The  origin  of  nearly  every  trial  for 
alleged  medical  malpractice  may  be  traced  to 
the  reckless  criticisms  which  rival  practitioners 
pass  upon  the  works  of  one  another.     Unguarded 


MEDICAL   MEN  VS.    MEDICAL   MEN.  287 

expressions  in  the  presence  of  patients  of  doubt 
as  to  the  propriety  of  methods  of  treatment,  or 
open  censure  of  the  results  attained,  pass  for 
positive  opinions  with  the  ignorant,  and  soon 
produce  their  legitimate  effects  in  the  prose- 
cution of  the  attending  physician.  At  the  trial 
which  follows,  an  accusing  medical  witness  will 
always  be  found  arrayed  on  the  part  of  the  prose- 
cution, who  is,  in  fact,  as  much  a  part  of  the 
prosecution  as  the  attorney.  His  evidence  is 
entirely  ex  parte,  and  he  exhibits  in  the  statement 
of  his  opinions  all  the  adroitness  of  the  legal 
counsel  in  making  them  bear  against  the  case  of 
the  defendant.  That  this  is  the  secret  history  of 
most  prosecutions  for  malpractice  every  one 
must  acknowledge  who  has  witnessed  many  of 
these  trials.  The  scene  which  is  enacted  in 
court  is  always  most  discreditable  to  those  mem- 
bers of  the  profession  who  instigate  the  proceed- 
ings or  who  appear  on  the  part  of  the  prosecution. 
Their  position  is  generally  false  both  in  fact  and 
ethics,  and  sooner  or  later  they  reap  the  just 
rewards  of  their  unprofessional  conduct.  It  is 
not  always  the  common  practitioner  who  takes 
this  stand  against  his  neighbor.  We  have  had 
notable  instances  of  men  eminent  in  special 
departments  of  practice,  who  have  allowed  the 
weight  of  their  evidence  to  appear  against  a 
medical  brother  when  their  opinions  were  unsup- 
ported by  facts.  We  have  seen  the  fair  fame  of 
young  physicians  suddenly  blasted,  and  a  good 


288  MEDICAL   MEN  VS.   MEDICAL   MEN. 

name  tarnished  by  the  alliance  of  some  opinion- 
ated "Professor"  with  the  prosecution.  Nay, 
more,  there  are  not  a  few  instances  in  which 
accomplished  physicians  have  retired  from  the 
profession  in  disgust  at  such  malicious  treatment 
by  their  seniors.  But  the  injury  thus  inflicted  is 
not  limited  to  the  defendant ;  the  profession  at 
large  suffers  severely  in  general  estimation. 
When  those  who  are  regarded  as  the  exponents 
of  medical  morals  array  themselves  in  courts  of 
justice  against  their  brethren,  and  with  denuncia- 
tory language  and  violent  gesticulation  not  only 
denounce  established  methods  of  treatment,  but 
attack  private  character,  the  public  confidence  in 
our  art  and  in  our  integrity  is  sadly  diminished. 
We  agree  with  the  British  Medical  Journal  : 

"  It  is  high  time  that  some  serious  steps  were  taken  by 
the  profession  to  put  clown  this  most  unseemly  persecution 
of  medical  men  by  medical  men.  How  often  have  we  not 
of  late  had  occasion  to  refer  to  such  scenes  as  these,  where 
medical  men  too  eagerly  appear  in  court  to  assist  in  the 
blasting  a  brother  practitioner's  fair  fame  !  The  very  fact 
of  men  in  the  position  of  Dr.  Lee  and  Ramsbotham  appear- 
ing in  the  case,  gives  an  immense  impulse  to  the  accusa- 
tion. Nay,  we  may  even  venture  to  believe  that,  but  for 
their  countenance,  such  an  action  as  this  could  never  have 
been  brought  at  all.  Is  it  not,  indeed,  reasonable  to  believe 
that  their  influence  could  have  even  arrested  the  action  ? 
Surely  no  men  should  know  better  than  they  how  scrupu- 
lously cautious  a  medical  man  should  be  in  accepting  the 
one-sided  statements  of  a  clever  hysterical  female ;  and 
especially  so  when,  as  was  evident,  the  blasting  of  Dr. 
W s'  fame  would  be  the  saving  of  her  own  reputation  !'' 


LVIII. 

THE    AKT    OF    TEACHING 
MEDICINE.* 


THE  art  of  teaching  medicine,  like  many  other 
arts,  reached  its  highest  development  du- 
ring the  earliest  period.  Necessity  compelled 
the  first  instructors  to  combine  theory  with  prac- 
tice, science  with  art,  didactic  with  clinical  in- 
struction. Hospitals  and  schools  were  united, 
the  one  being  the  complement  of  the  other.  The 
carefully  compiled  records  of  observation  and  ex- 
perience formed  the  test-books  of  the  student ; 
and  the  immediate  application  of  the  principles 
and  precepts  learned  at  the  bed-side  of  the  sick, 
and  under  the  direction  of  the  master,  completed 
the  curriculum  of  daily  study.  This  is  the  ra- 
tional system  of  teaching — at  once  the  most 
thorough  and  efficient — and  should  never  have 
been  departed  from.  "We  can  not  better  improve 
the  present  hour  than  by  tracing  its  origin,  prog- 
ress, and  complete  development.  "We  may  thus 
learn  what  are  the  defects,  as  well  as  advantages 
of  the  past  and  present  methods  of  instruction, 

*  Remarks  made  at  the  opening  of  the  course  at  Bellevue  Hos- 
pital. 

13 


290  THE   ART  OF  TEACHING   MEDICINE. 

and  apply  the  practical  lessons  which,  this  review 
Avill  inculcate. 

Among  people  of  high  antiquity,  the  first  effort 
to  systematize  the  treatment  of  the  sick  consisted 
in  exposing  them  in  public  places,  in  order  that 
any  passers-by,  who  had  been  similarly  afflicted 
and  cured,  might  give  their  advice  for  the  benefit 
of  the  sufferers.  At  a  later  period,  those  who 
had  been  cured  of  diseases  were  required  to  go 
and  deposit  in  the  temples  a  votive  tablet,  which 
was  a  detailed  account  of  the  symptoms  of  their 
diseases,  and  the  remedial  agents  which  had  been 
beneficial  to  them.  It  very  soon  became  popular 
to  visit  by  preference  some  temples  of  great  and 
wide-spread  fame,  and  these,  therefore,  were  in 
time  made  the  principal  depositories  of  the  regis- 
ters of  the  sick.  These  records  were  kept  with 
the  same  care  as  the  archives  of  the  nation.  At 
first  they  were  open  for  inspection  and  con- 
sultation by  the  public.  Every  one  had  the  right 
and  privilege  of  consulting  them  personally,  and 
of  choosing  for  his  sickness,  or  that  of  his  friend, 
the  remedies  which  long  experience  had  here 
recorded.  Every  man  thus  became  his  own 
doctor — a  system  which  has  in  our  day  been 
revived,  which  places  in  the  hands  of  the  pa- 
tient a  record  of  symptoms,  each  offset  by  its 
appropriate  remedy.  But  it  was  found  to  be  in- 
convenient as  well  as  dangerous  to  allow  the  com- 
mon people  to  prescribe  for  their  own  diseases. 
Symptoms  were    misinterpreted,    and    remedies 


THE   ART   OF   TEACHING   MEDICINE.  291 

were  misapplied.  The  records  were  therefore 
withdrawn  from  public  scrutiny,  and  placed  in 
the  exclusive  charge  of  the  priests  who  ministered 
in  the  several  temples.  The  sick  now  related 
their  symptoms  to  the  official  organ,  who  in  his 
turn  consulted  the  tablets  or  records,  and  pre- 
scribed the  proper  remedies,  and  received  in  be- 
half of  the  presiding  deity  the  votive  offering. 
The  priests  having  thus  the  exclusive  control  of 
all  the  recorded  facts  and  observations  in  medi- 
cine, and  having  monopolized  the  practice  of  the 
art,  endeavored  to  reduce  their  knowledge  to  a 
system.  The  records  were  carefully  revised  and 
collated,  and  finally  formed  into  a  medical  code, 
which  they  called  the  Sacred  Book.  This  book 
was  the  undeviating  guide  to  medical  practice  for 
centuries.  Whoever  departed  from  its  precepts 
and  injunctions  did  so  at  the  peril  of  his  life. 
We  here  trace  the  beginning  of  the  legal  responsi- 
bilities of  medical  men.  Under  this  medical  code 
occurred  the  first  prosecutions  for  malpractice, 
and  the  physician  found  guilty  of  ignoring  its 
aphorism  was  condemned  to  death. 

We  can  not  be  surprised  that  the  ancients 
attached  so  much  importance  to  this  volume.  It 
embodied  the  whole  science  of  medicine  ;  it  con- 
tained the  aggregate  experience  of  centuries.  It 
was  the  most  precious  legacy  which  the  past  had 
bequeathed  to  the  present.  It  was  a  faithful 
transcript  of  the  ever-varying  phenomena  of  dis- 
ease, and  the  only  guide  to  the  use  of  remedies 


292  THE    ART   OF   TEACHING    MEDICINE. 

To  doubt  its  sacred  aphorisms  was  to  cavil  at  the 
laws  of  nature.  It  was  a  medical  book  without  a 
theory.  It  contained  only  facts.  And  so  it  was 
received  as  the  great  statute-book  of  ancient 
medicine.  The  temples  where  the  sick  congre- 
gated were  the  hospitals  of  that  period,  and  the 
votive  tablets  were  the  clinical  records  of  the 
diseases.  These  temples  became  in  time  the  great 
centres  of  medical  knowledge  and  education. 
Thither  students  flocked  from  distant  States  and 
foreign  countries  to  drink  at  the  original  foun- 
tains of  experience.  Men  of  genius  and  cultiva- 
tion here  attained  to  a  profound  knowledge  of  the 
recorded  wisdom  of  the  past,  and  became  skilled 
in  the  practical  application  of  that  knowledge  to 
the  relief  or  mitigation  of  human  infirmities.  As 
their  fame  spread  they  attracted  pupils,  and  at- 
taching themselves  to  the  temples,  in  turn  became 
practical  teachers  of  the  art  of  healing.  Thus 
arose  schools  of  medicine  in  near  and  remote  coun- 
tries, many  of  which  attained  to  great  eminence, 
and  had  a  lasting  influence  upon  the  future  history 
of  medicine.  Great  as  was  the  veneration  for  the 
Sacred  Book,  and  binding  as  were  its  precepts 
upon  teachers  and  pupils,  it  could  not  entirely 
restrain  within  the  bounds  of  rational  inquiry  the 
free  play  of  the  human  mind.  A  class  of  teach- 
ers in  time  appeared,  who  discarded  observation 
and  experience,  and  appealed  to  reason  and  the 
suggestions  of  the  imagination.  The  plain,  prac- 
tical, and  unyielding  axioms  of  the  medical  code, 


THE  ART   OP   TEACHING   MEDICINE.  293 

confirmed  by  long  practice  and  supported  by  the 
authority  of  the  greatest  masters  of  the  art,  were 
but  so  many  clogs  and  hindrances  to  speculation. 
The  immutable  facts  of  science  were  employed  as 
the  scaffolding  to  the  theories  which  they  in- 
geniously constructed,  and  when  they  had  served 
that  purpose  were  rejected  as  worthless  material. 
They  no  longer  sought  to  add  their  quota  to  the 
records  of  their  predecessors.  They  forsook  the 
temples,  and  betook  themselves  to  retired  and 
undisturbed  retreats.  They  became  pure  theo- 
rists. 

In  the  little  Republic  of  Greece,  at  a  period 
somewhat  later,  ancient  civilization  shone  forth 
with  unwonted  splendor.  Philosophy  and  the 
fine  arts  were  cultivated  with  passionate  fond- 
ness, and  in  their  turn  they  quickened  the  intel- 
lect to  an  extraordinary  degree.  The  imagina- 
tion supplanted  reason,  and  speculation  was 
preferred  to  deduction.  Theories  were  built  up 
on  foundations  which  crumbled  to  pieces  even 
while  the  architect  was  moulding  the  superstruc- 
ture to  his  taste.  Not  only  did  the  philosophers 
of  that  age  devise  systems  on  subjects  beyond 
the  range  of  observation,  but  they  frequently  re- 
jected the  teachings  of  experience,  and  all  positive 
knowledge,  and  abandoned  themselves  to  idle 
dreaming.  Forsaking  the  paths  of  logical  induc- 
tion and  deduction,  they  began  to  reconstruct  the 
infant  sciences  on  the  shallow  basis  of  hypothe- 
sis.    Medicine,  still  wrapped  in  mystery,  proved 


294  THE    ART   OF   TEACHING   MEDICINE. 

to  be  a  most  fruitful  field  for  cultivation,  by 
these  transcendental  philosophers.  Nor  were 
they  long  in  entering  it,  nor  scrupulous  in  the  use 
of  means  to  revolutionize  both  its  theory  and  its 
practice.  Two  schools  of  medicine  now  arose  in 
Greece,  with  sharply  defined  peculiarities.  Each 
had  its  special  method  of  studying  and  teaching, 
and  both  have  impressed  their  customs  upon  all 
succeeding  generations.  The  first  adopted  the 
Sacred  Book  as  the  safe  and  unerring  guide  to 
truth.  It  still  located  itself  within  the  sacred 
precincts  of  the  temples  where  the  sick  congre- 
gated, thus  basing  its  system  of  teaching  upon 
observation  and  experience.  It  accepted  no  as- 
serted fact  as  true,  and  deemed  it  unworthy  even 
of  consideration,  unless  it  had  been  subjected  to 
rigid  experimentation.  Every  disease  was  inves- 
tigated in  the  light  of  the  sacred  record — the 
science  of  that  time — and  every  remedy  was  ap- 
plied with  the  exactest  detail.  The  student  was 
forbidden  seclusion.  He  was  constantly  brought 
face  to  face  with  disease  in  all  its  forms,  and  com- 
pelled to  make  a  practical  application  of  his 
knowledge.  Beason  was  allowed  its  full  scope  in 
the  construction  of  theories  and  systems,  but  its 
premises  must  be  fixed  and  indisputable  facts. 
Every  pupil  was  required  to  follow  rigid,  logical 
induction  and  deduction,  when  he  departed  from 
the  axioms  of  the  past.  This  was  pre-eminently 
a  practical  school ;  it  was  also  a  clinical  school ; 
it  was  the  basis  of  scientific  orthodox  medicine ; 


THE   ART   OF   TEACHING   MEDICINE.  295 

and  from  it  sprang  the  rational  system  of  study- 
ing and  teaching.  Opposed  to  this  demonstra- 
tive method  were  the  theorists.  They  withdrew 
from  the  temples,  to  them  denied  by  the  presence 
of  the  sick,  and  betook  themselves  to  quiet  groves 
and  secluded  retreats,  where  nothing  would  di- 
vert their  thoughts,  or  obstruct  the  full  play  of 
the  imagination.  Here  their  classes  assembled 
and  listened  to  fine-spun  theories  on  the  essences, 
on  the  prognostic  value  of  particular  numbers,  on 
the  indications  of  dreams,  on  the  influence  of  the 
moon  upon  the  sick,  or  on  the  therapeutic  uses  of 
plants  according  to  their  color.  Doubtless  they 
felt  the  pressure  of  the  popularity  of  the  clinical 
school,  and  on  certain  days  compelled  a  few  sick 
vagrants  to  visit  their  classes,  when  the  professor 
explained  to  his  distant  and  wondering  pupils 
how  precisely  the  disease  had  conformed  to  his 
theory.  With  his  own  finger  he  touched  the 
pulse  and  informed  the  pupils  how  it  felt ;  with 
his  own  hands  he  applied  each  dressing  and 
manipulated  the  affected  part.  The  pupi]  was 
left  to  doubt  and  conjecture,  or  in  after  times  to 
repeat  his  lesson  as  an  experiment  upon  his  pa- 
tients.    All  was  theory — nothing  was  practical. 

The  Practical  or  Clinical  School  of  the  great- 
est renown  was  located  on  the  Island  of  Cos, 
in  the  temple  of  Esculapius.  Its  head  was  the 
Father  of  Rational  Medicine — Divine  Hippoc- 
rates. At  this  brilliant  period  in  the  history  of 
Greece — the  age  of  Pericles,  of  Socrates,  of  Plato — 


296  THE    ART   OF   TEACHING   MEDICINE. 

Hippocrates  was  one  of  the  most  eminent  philoso- 
phers. He  was  one  of  the  best  observers  and 
one  of  the  most  profound  thinkers  of  that  or  in- 
deed of  any  other  age.  His  works  are  the  very 
perfection  of  philosophical  writing.  They  are  re- 
markable for  accuracy  of  observation,  precision 
of  detail,  and  severity  of  logic.  He  seems  to  have 
rigidly  scrutinized  every  recorded  observation 
and  practically  applied  every  precept  of  his 
predecessors.  Trained  to  the  closest  habits  of 
study  and  investigation  in  the  clinical  school,  he 
was  prepared  to  advance  beyond  the  limits  of  ex- 
isting knowledge,  and  add  largely  to  the  sum  of 
positive  facts  and  practical  principles  in  our  art. 
He  reconstructed  the  groundwork  of  rational 
medicine,  extended  and  perfected  its  foundations, 
and  added  not  a  little  to  the  beautiful  superstruc- 
ture which  it  is  our  privilege  to  witness  so  near 
its  completion.  Hippocrates  is  justly  regarded 
as  the  Father  of  Medicine.  He  was  no  less  truly 
the  Father  of  cluneal  teaching.  The  greatness 
and  influence  of  the  School  of  Cos  grew  out  of  its 
eminently  practical  character.  It  arose  to  great 
and  deserved  eminence,  not  more  through  the 
wide-spread  fame  of  its  founder,  than  the  rigid 
system  of  teaching  which  it  practiced.  Students 
annually  gathered  at  the  temple  of  Esculapius 
from  every  portion  of  Greece,  and  from  coun- 
tries beyond  the  seas.  An  elegant  writer  has 
pictured  to  us  the  opening  of  a  course  of  lec- 
tures at  this  famous  school.     He  remarks  :  "  Near 


THE   ART   OF   TEACHING   MEDICINE.  297 

a  column  of  the  temple,  and  holding  a  roll  of 
papyrus  in  his  left  hand,  stands  Hippocrates. 
Gathered  about  him  in  picturesque  little  groups 
there  is  a  company  of  Greek  youths.  Their 
tasteful  and  elegant  costumes,  their  earnest  and 
intelligent  faces,  and  their  general  air  and  bear- 
ing, all  show  plainly  enough  the  superior  refine- 
ment and  culture  of  the  class  to  which  they 
belong.  They  are  medical  students  who  have 
assembled  here  from  the  several  States  of  Greece, 
to  acquire  the  clinical  skill  and  experience  of  the 
great  surgeon  and  physician  of  Cos,  and  to  listen 
to  the  eloquent  lessons  of  the  illustrious  pro- 
fessor." 

If  we  examine  the  works  of  Hippocrates  it 
will  not  be  difficult  to  determine  what  were  the 
heads  of  this  introductory  discourse.  We  hear 
him  saying  in  language  full  of  significance — 
"  Medicine  is  of  all  the  arts  the  most  noble,  but 
owing  to  the  ignorance  of  those  who  practice  it, 
it  is  at  present  far  behind  all  the  other  arts. 
There  is,  unfortunately,"  he  adds,  "no  punish- 
ment visited  upon  the  ignorant  physician,  except 
disgrace,  and  that  does  not  hurt  those  who  are 
familiar  with  it.  Such  persons  are  like  the 
figures  which  are  introduced  in  tragedies,  for 
as  they  have  the  shape,  and  dress,  and  personal 
appearance  of  actors,  but  are  not  actors,  so  also 
physicians  are  many  in  title  but  very  few  in  real- 
ity." Turning  to  those  who  were  commencing 
the  study,  he  says :  "  "Whoever  is  to  acquire  a 
13* 


298  THE    ART   OF   TEACHING   MEDICINE. 

competent  knowledge  of  medicine,  ought  to  be 
possessed  of  the  following  advantages :  a  nat- 
ural disposition ;  instruction ;  a  favorable  posi- 
tion for  the  study  ;  early  tuition  ;  love  of  labor  ; 
leisure.  First  of  all,  a  natural  talent  is  required  ; 
for,  when  nature  opposes,  everything  else  is 
vain  ;  but  when  nature  leads  the  way  instruction 
is  easy,  and  the  student  readily  appropriates  the 
principles  to  himself.  He  must  also  bring  to  the 
task  a  love  of  labor  and  perseverance,  so  that 
the  instruction  taking  root,  may  bring  forth 
proper  and  abundant  fruits.  Instruction  in 
Medicine  is  like  the  culture  of  the  productions 
of  the  earth.  For  our  natural  disposition 
is,  as  it  were,  the  soil ;  the  tenets  are,  as 
it  were,  the  seed ;  instruction  in  youth  is  like 
the  planting  of  the  seed  in  the  ground  at  the 
proper  season  ;  the  place  where  the  instruction 
is  communicated  is  like  the  food  imparted  to 
vegetables  by  the  atmosphere  ;  diligent  study 
is  like  the  cultivation  of  the  fields.  Having 
brought  all  these  requisites  to  the  study  of  med- 
icine, and  having  acquired  a  true  knowledge  of 
it,  you  will  be  esteemed  physicians  not  only  in 
name,  but  in  reality.  But  inexperience  is  a  bad 
treasure,  and  a  bad  fund  to  those  who  possess  it, 
whether  in  opinion  or  in  reality ;  it  is  the  source 
of  both  timidity  and  audacity."  The  degree  of 
knowledge  to  which  they  were  to  attain  he  thus 
defines  : — "  It  is  the  business  of  the  physician 
to  know,  in  the  first  place,   things  similar  and 


THE    ART   OF    TEACHING   MEDICINE.  299 

things  dissimilar ;  those  connected  with  things 
most  important,  most  easily  known,  and  in  any- 
wise known  ;  which  are  to  be  seen,  touched,  and 
heard ;  which  are  to  be  perceived  in  the  sight, 
and  the  touch,  and  the  hearing,  and  the  nose, 
and  the  tongue,  and  the  understanding ;  which 
are  to  be  known  by  all  the  means  we  know  other 
things."  Enlarging  upon  these  and  kindred 
topics — all  exhibiting  an  intensely  practical  mind 
— he  must  have  alluded  in  terms  of  severe  sar- 
casm to  the  schools  of  the  theorists,  which  re- 
jected the  humble  teachings  of  nature,  and  oc- 
cupied themselves  with  vain  imaginings.  In 
conclusion,  he  thus  addresses  those  who  were 
attending  their  last  course  of  lectures,  and  were 
about  to  enter  upon  the  responsible  duties  of 
their  profession :  "When  you  have  selected  the 
city  of  your  future  residence,  consider  well  its 
situation — how  it  lies  as  to  winds  and  the 
rising  of  the  sun — whether  north  and  south  or 
east  and  west ;  consider  also  attentively  the  waters 
which  the  inhabitants  use,  whether  they  be 
marshy  and  soft,  or  hard,  and  running  from 
elevated  and  rocky  situations,  and  then  if  saltish 
and  unfit  for  cooking.  And  the  ground,  whether 
it  be  naked  and  deficient  in  water,  or  wooded 
and  well  watered,  and  whether  it  lies  in  a  hollow, 
confined  situation,  or  is  elevated  and  cold  ;  and 
the  mode  in  which  the  inhabitants  live,  and  what 
are  their  pursuits,  whether  they  are  fond  of 
drinking  and  eating  to  excess,  and  given  to  indo- 


300  THE    ART   OF   TEACHING   MEDICINE. 

lence,  or  are  fond  of  exercise  and  labor,  and  not 
given  to  excess  in  eating  and  drinking.  From 
these  things  you  must  proceed  to  investigate 
evervthino:  else.  For  if  vou  know  all  these  things 
well,  you  cannot  miss  knowing  either  the  dis- 
eases peculiar  to  the  place,  or  the  particular  na- 
ture of  common  diseases.  Thus  you  will  be  able 
to  foretell  what  epidemic  will  attack  the  city, 
either  in  summer  or  winter,  and  what  each  indi- 
vidual will  be  in  danger  of  experiencing  from  the 
change  of  regimen.  You  will  also  not  be  in 
doubt  as  to  the  treatment  of  the  prevailing  dis- 
eases." His  address  concludes  with  that  solemn 
and  sublime  admonition  so  frequently  quoted,  but 
so  little  heeded :  "  Life  is  short,  and  the  Art 
long  ;  the  occasion  fleeting." 

"With  such  views  of  the  nature  of  the  studies 
and  duties  of  physicians,  we  cannot  doubt  what 
was  the  curriculum  of  study  in  the  school  of  Cos 
during  this  period.  First,  the  great  Master 
opened  the  Sacred  Book,  the  volume  of  science, 
and  expounded  one  by  one  the  aphorisms,  ex- 
plaining on  what  exact  observation  each  was 
based,  and  what  was  its  practical  significance. 
Then  grouping  together  such  as  had  some  spe- 
cial or  general  relation,  he  constructed  systems 
having  for  their  bases  logical  deductions  from 
established  premises.  From  the  lecture  they 
proceeded  to  the  apartments  devoted  to  the  sick, 
where  each  student  in  turn  was  instructed  by  the 
master  in  the  practical  application  of  the  truths 


THE    ART   OF   TEACHING   MEDICINE.  301 

or  principles  just  taught.  Each  student  -with 
his  own  finger  learned  the  exact  nature  of  the 
pulse  in  every  form  of  disease ;  with  his  own 
hands  he  applied  the  most  complicated  as  well 
as  the  most  simple  surgical  dressings ;  with  his 
own  eyes  he  studied  the  physiognomy  of  dis- 
ease. Thus,  under  the  medical  supervision  of 
the  Master,  he  so  studied  and  practiced  his  pro- 
fession as  to  become  an  expert  in  every  branch 
— both  of  its  science  and  of  its  art.  It  is  not  sur- 
prising that  the  School  of  Cos,  the  great  clinical 
schaol  of  the  past,  became  so  famous,  and  at- 
tracted pupils  from  such  a  distance  and  in  such 
immense  numbers.  Its  graduates  went  forth 
prepared  for  any  emergency  in  practice.  They 
began  their  career  at  an  advantage  which  their 
rivals  of  the  theoretical  schools  did  not  attain  in 
a  score  of  years  of  active  duty.  From  the  first 
they  were  skilful,  hence  confident,  bold,  and  ag- 
gressive, while  their  competitors  were  timid,  hes- 
itating, and  faltering.  Throughout  all  Greece 
they  became  the  chief  physicians,  and  their  ser- 
vices were  often  in  demand  at  foreign  courts. 
The  true  glory  of  the  ancient  clinical  school  was 
in  the  practical  union  of  the  science  and  art  of 
medicine  in  teaching.  The  hospital  was  the 
basis  of  the  school ;  science  was  the  guide  and 
instructor  of  art  ;  precept  and  practice  went 
hand  in  hand.  The  student  personally  learned 
"  everything  which  is  perceived  in  the  sight,  and 
the  touch,  and  the  hearing,   and  the  nose,  and 


302  THE   ART   OF   TEACHING   MEDICINE. 

the  tongue,  and  the  understanding."  To  remove 
the  school  from  the  hospital,  was  to  divorce  two 
branches  of  education  mutually  dependent  upon 
each  other  for  life,  and  even  vitality.  Educated 
in  the  science  of  his  profession  only,  the  stu- 
dent had  no  power  to  apply  his  knowledge. 
Educated  only  in  the  art,  he  had  no  knowledge 
to  apply.  The  true  physician  must  therefore  be 
educated  in  the  hospital-school.  The  clinical 
schools  long  maintained  their  supremacy.  The 
intrinsic  merits  of  their  methods  of  teaching,  the 
high  and  influential  positions  which  their  gradu- 
ates attained,  and  the  overshadowing  influence 
of  the  great  master  of  the  school,  gave  them 
power  and  permanence.  But  in  time  they  were 
corrupted,  their  customs  perverted,  and  finally 
they  disappeared  in  that  night  of  universal  su- 
perstition, the  Dark  Ages.  The  clinical  method 
of  teaching  was  henceforth  numbered  among  the 
lost  arts.  Here  and  there  in  the  succeeding  cen* 
turies  we  find  a  great  mind  seizing  the  grand 
idea  of  the  Father  of  Medicine,  and  developing 
the  rational  system  of  teaching.  Boerhaave,  the 
modern  Hippocrates,  deserves  especial  mention, 
as  he  followed  the  original  method  of  clinical  in- 
struction, and  with  great  success ;  students 
flocked  to  him  from  every  part  of  Europe,  and 
he  became  the  most  eminent  instructor  of  his 
age. 

In  our  own  time  there  is  a  tendency  to  revive 
tli3  Clinical  or  Practical  Schools  of  the  ancients. 


THE    ART   OF   TEACHING   MEDICINE.  303 

In  Europe,  and  in  England  especially,  the  union 
of  medical  schools  and  hospitals  is  recognized 
as  essential  to  the  true  success  of  the  former. 
The  advantages  that  flow  from  this  union  are 
seen  in  the  high  standard  of  medical  education 
which  is  maintained  abroad,  the  rapid  develop- 
ment of  the  medical  sciences,  and  the  practical 
character  of  the  general  practitioner.  In  our 
own  country  the  value  of  clinical  instruction  has 
long  been  recognized,  and  feeble  attempts  have 
been  made  to  supply  the  deficiency  in  the  medi- 
cal colleges.  But  instead  of  removing  the  col- 
leges to  the  hospitals,  the  teachers  invite  the 
sick  to  visit  their  class-rooms  and  repeat  the 
story  of  their  sufferings.  The  student  and  pa- 
tient are  not  brought  in  contact,  and  the  Distrac- 
tion imparted,  however  valuable  in  itself,  is  prac- 
tically lost.  The  student  must  learn,  if  he  learn 
at  all,  by  proxy.  How  much  such  knowledge 
will  avail  him  when  in  after  years  he  endeavors 
at  the  bedside  to  apply  it,  every  one  can  truly 
estimate.  Such  schools  are  the  theoretical 
schools  of  the  ancients.  They  teach  theories 
and  systems,  but  they  do  not  teach  practical 
medicine.  They  educate  the  brain,  but  leave  the 
hand  palsied,  the  eye  blind,  and  the  ear  deaf. 
Their  graduates  go  forth  to  practical  life  like 
full-fledged  eaglets  deprived  of  wings.  They 
lack  the  one  thing  needful  to  early  and  complete 
success — -the  power  or  ability  to  use  their  knowl- 
edge.    Any  system    of  medical   education   that 


304:  THE   ART   OF   TEACHING   MEDICINE. 

does  not  supply  this  defect  is  unworthy  the  sup- 
port of  the  profession.  And  such  will  yet  be  its 
most  emphatic  verdict.  The  plan  of  uniting  di- 
dactic and  clinical  instruction  by  the  union  of 
schools  and  hospitals,  has  been  much  agitated 
within  the  last  few  years,  and  has  received  a  cor- 
dial support  from  the  body  of  practitioners. 
Many  schoolmen  have  opposed  it  with  argument 
and  ridicule,  but  every  physician  finds  in  his 
own  experience  overwhelming  counter  argu- 
ments. How  many  times  in  the  simplest  opera- 
tions or  manipulations  has  he  been  embarrassed, 
and  perhaps  foiled,  for  the  want  of  an  educated 
touch  ?  How  frequently  has  he  striven  in  vain 
to  discriminate  physical  signs  for  the  want  of  an 
educated  ear?  How  many  who  have  never  had 
clinical  advantages,  have,  after  years  of  toil  in 
practice,  been  easily  supplanted  by  the  student 
fresh  from  the  hospital?  Such  arguments  can 
not  be  answered  except  by  shallow  sophistry* 
The  tide  of  professional  sentiment  has  been  set- 
ting more  and  more  strongly  in  favor  of  a  radi- 
cal change  in  our  system  of  education.  The 
profession  has  demanded  that  it  should  be  mere 
thorough  and  more  practical.  There  can  be  but 
one  change  which  can  meet  the  requirements  of 
practitioners — and  that  is,  a  return  to  the  primi- 
tive system — -the  union  of  hospitals  and  schools. 
It  is  scarcely  half  a  dozen  years  since  the  first 
effort  was  made  in  this  country  to  unite  clinical 
aid  didactic  instruction,  and  to-day  we  witness  its 


THE   ART   OF   TEACHING   MEDICINE.  305 

complete  triumph.  "We  have  laid  the  founda- 
tions of  an  hospital  school  within  the  sacred 
precincts  of  these  temples  where  the  sick  con- 
gregate in  such  vast  numbers.  Here  the  science 
and  art  of  medicine  are  indissolubly  united,  the 
one  being  the  helpmate  of  the  other.  Here  pre- 
cept and  practice  have  embraced  each  other,  no 
more  to  be  separated.  To  these  temples  the 
sick  turn  their  steps  by  thousands,  each  bearing 
the  votive  tablet  to  be  placed  conspicuously  for 
your  study.  Here  you  may  learn  every  phase 
and  aspect  of  disease  from  living  records,  and 
accustom  every  sense  to  the  quick  perception  of 
its  ever-varying  phenomena.  Here  you  may 
open  a  book  far  more  sacred  than  that  which  the 
ancients  so  much  venerated,  and  study  the  rough 
sketches  or  delicate  outlines  of  disease  which 
pathology  unfolds.  From  these  seats,  where 
you  learn  the  principles  of  medicine,  you  go 
directly  to  the  wards  and  personally  test  their 
value,  and  study  the  practical  application  of 
each  aphorism.  Here  you  may  become  learn- 
ed in  every  branch  of  the  medical  sciences ; 
there  you  may  become  skilled  in  every  de- 
partment of  the  art  of  healing.  We  have  in 
this  college  practically  answered  Wo  objections 
to  a  clinical  school.  The  first  is  that  students 
are  liable  to  be  diverted  from  the  study  of  the 
science  of  medicine  by  attendance  upon  clini- 
cal instructions.  The  opposite  has  proved  to 
be  true.     The  student  most  devoted  to  clinical 


306  THE   ART   OF   TEACHING   MEDICINE. 

study,  has  also  been  the  most  thoroughly  versed 
in  the  principles  of  his  art.  This  fact  has  been 
observed  of  students  who  commenced  their  stud- 
ies with  clinical  and  didactic  instruction  com- 
bined. And  it  is  but  natural  that  this  should  be 
the  universal  rule.  "Why  should  the  student  of 
auscultation  master  the  entire  science  by  study 
in  a  closet  before  he  begins  to  accustom  his  ear 
to  the  normal  and  abnormal  sounds  of  the  lungs 
and  heart  ?  The  ear,  the  eye,  the  hand,  are  to 
be  educated  by  long  and  skilful  training  as  well 
as  the  mind,  and  no  time  should  be  lost  in  the 
short  course  of  study  allotted  to  the  student. 
If  this  training  for  practical  duties  is  postponed 
to  a  later  and  more  convenient  day,  experience 
proves  that  it  will  never  be  accomplished.  It 
has  also  been  alleged  that  clinical  teaching  is  in- 
jurious to  the  patient.  Whoever  has  lingered 
behind  the  class  in  the  wards  to  examine  special 
cases  more  at  leisure,  has  not  failed  to  find  pa- 
tients complaining  that  the  doctors  had  passed 
them  by  without  notice.  They  believe  that  the 
whole  class  are  consulting  upon  their  cases. 
They  are  not  only  anxious  to  have  a  large  num- 
ber interested  in  their  diseases,  but  those  exam- 
ined are  often  proud  and  boastful  of  the  atten- 
tion which  they  have  received.  From  long  per- 
sonal experience  in  hospital  practice,  I  am  satis- 
fied that  clinical  teaching  is,  with  rare  excep- 
tions, useful  to  the  patient.  It  revives  his  hope, 
and  satisfies  his  longing  for  sympathy  and  atten- 


THE    ART  OF   TEACHING   MEDICINE.  307 

tion.  But  while  it  is  true  that  the  sick  not  only 
cheerfully  submit  to  physical  examination  but 
are  often  much  gratified,  the  student  should 
not  be  unmindful  of  the  fact  that  he  must  handle 
them  gently.  The  first  lesson  that  you  should 
learn  in  clinical  instruction  is  never  to  cause  un- 
necessary pain.  By  gentleness  you  ensure  the 
patient's  confidence,  and  render  your  examina- 
tion useful  to  yourself  and  pleasing  to  the  sick. 

You  are  now  surrounded  by  every  means  nec- 
essary to  your  complete  medical  education.  The 
result  must  rest  with  each  individual  student. 
No  limit  is  set  to  your  acquirements.  You  may 
during  your  pupilage,  become  profoundly  versed 
in  any  or  all  branches  of  your  profession.  No 
greater  facilities  than  are  now  at  your  command 
can  you  require  for  the  successful  study  of  anat- 
omy, physiology,  chemistry,  materia  medica,  sur- 
gery, practical  medicine,  and  obstetrics.  The 
opportunity  which  this  hospital  affords  you  for 
becoming  personally  familiar  with  every  depart- 
ment of  practice,  are  unlimited.  No  student 
should  go  out  from  this  class  unprepared.  He 
has  but  to  put  forth  his  hand  to  become  skilled 
in  minor  surgery,  to  use  his  ear  to  become  ex- 
pert in  auscultation,  to  exercise  his  reason  to  be 
learned  in  diagnosis,  prognosis,  and  therapeu- 
tics. Never  was  the  medical  student  stimulated 
by  so  many  incitements  to  perfect  himself  in  all 
his  studies.  Our  navy,  rapidly  expanding,  is  in 
such  need  of  educated  surgeons  that  promotion 


308  THE   ART   OF   TEACHING   MEDICINE. 

to  the  highest  rank  occurs  in  the  second  year. 
The  army  has  absorbed  thousands,  and  still  calls 
for  more.  But  the  army  and  navy  will  have  only 
the  best.  I  wish  it  were  in  my  power  on  this  oc- 
casion, the  commencement  of  a  course  of  lectures, 
to  point  out  to  you  the  royal  road  to  knowledge, 
or  to  place  in  your  hands  a  book  in  which  the 
study  of  medicine  is  made  easy.  But  this  I 
cannot  do.  That  road  remains  undiscovered, 
that  book  remains  unwritten.  Great  as  has  been 
the  advance  of  the  sciences,  wonderful  as  are  the 
means  by  which  they  have  enabled  man  to 
cheapen  labor  and  mitigate  the  rigors  of  the  pri- 
mal curse,  they  have  as  yet  failed  to  discover  a 
method  by  which  a  student  may  sleep  in  the 
class-room  and  inhale  knowledge,  or  saunter  idly 
in  the  wards  and  become  an  expert  even  in  the 
simplest  art.  "Whatever  dream  you  may  have  in- 
dulged of  acquiring  a  profession  without  labor 
should  to-day  be  dissipated.  Effort  and  unceas- 
ing toil  are  the  true  aids  to  success.  Let  yours 
be  the  motto  of  the  ancient  Hippocratic  school : 

Life  is  short, 

and  the  art  long  ; 

the  occasion  fleeting. 


&> 


ctA&frcr 


UC  SOUTHERN  REGIONAL  LIBRARY  FACILITY 


AA      000  221  032    6 


